World Class Teaching Mentor Program Credit Application

Please complete the below evaluation about your online course experience.
Which credit are you applying for?*
If you are applying for the Mentor Meetings, Please select which date you have completed your Mentor Meetings.
Upload Attendence Verification*
Accepted file types: pdf, jpg, png, jpeg, Max. file size: 64 MB.
Email Tammy Kirkland: tkirkland@olemiss.edu for attendance verification
Completion Date*
Mentor*
Personal Information
Name*
First Last
Email*
Cell Phone*
Address*
Street Address City State ZIP Code
Birthday (Include Year)*
Educator ID*
School*
Payment Information
Which credit are you applying for?*
- CEUs
Payment Method*
- $16.50 - Credit/Debit Card
- $15.00 - Check/Money Order
World Class Teaching Mentor Program
Price:
Total Due
$0.00

Please complete the below evaluation about your online course experience.