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Registration Form Advanced Certificate

in

Resource Education

NOTE: Official transcripts from the post-secondary institution which granted your Bachelor of Education degree must be submitted to the Registrar’s Office prior to the third week of the first course for which you register. Registrar’s Office, Box 6004, Moncton, NB, E1C 9L7, ATTN: Marybeth Clements.

Personal Information Name

Last

First

Address

Street/P.O.

Middle

City

Home Phone

Work Phone

Date of Birth:

Prov./State

Postal/Zip Code

E-mail

  Have you ever attended Crandall?   If so, what year(s)? 

MM/DD/YYYY

Background Information Current Level of Certification:   

Current School District:   

Current School: 

Degrees completed/Universities attended:  

Registration Information

Office Only

List all courses for which you are registering: Course Number (i.e. ED6706A)

Course Title           Start Date (mm/dd/yyyy)

Amount

























Financial Information Please be advised that I hereby authorize Crandall University to charge the $150.00 enrolment deposit to my Visa or Mastercard as I instruct them below for the student named on this form. By signing this form it will have the same force as if I have signed the Visa/Mastercard slip myself. Name of Cardholder (please print):

Phone Number: 

Card number:

Expiry Date: 

Visa

Mastercard

*a receipt will be mailed to the address listed above

Please check the appropriate boxes: Enrolment deposits ($150.00 per course listed above; non-refundable) Course tuition ($1,520.00 per 6 credit hour course; $760.00 per 3 credit hour course; subject to change as of July 1; due at course start date) Total amount to be charged: $ Cardholder Signature:

Date: 

This form can be faxed to (506) 858-9694 or mailed to: Crandall University, P.O. Box 6004, Moncton, NB E1C 9L7, ATTENTION: Marybeth Clements, Assistant Registrar for Professional Studies or Kimberley Cook, Program Administrator for the Professional Studies Division. For more information dial (506)858-8970 or email marybeth.clements@crandallu.ca or kimberley.cook@crandallu.ca.

formerly known as Atlantic Baptist University


Resource registration form