Individual Enrollment Form

For individuals: please complete the following enrollment form and pay via credit card.

First name*

Last name*

Email*

School name*

District name*

Position*

Years as teacher of record*

Elementary or secondary *

Elementary

Secondary

Enter grade level detail*

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Content area detail*

What do you hope to learn/gain from this program?*

Please use this space to share any specific learning needs or accommodations we should be aware of*

Please list what curriculum you will be using next year*

Select your registration *

Individual Registration$650

GET IN TOUCH

First name*

Last name*

Email*

Subject

Message

67 Kemble Street, Suite 2.5
Boston, MA 02119
Email: cchen@bpe.org

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