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Carthage Act 20 Training Registration Form

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PLEASE NOTE: This registration form is exclusively for those seeking to complete training to comply with Wisconsin's Act 20 for teacher licensure. For all other candidates, please use our undergraduate/bachelor's application or our graduate/master's application instead.

The Carthage Act 20 Training Registration Form takes only ~10 minutes to complete and should be filled out in a single sitting. You will not be able to save and return later.

The training includes 40 hours of asynchronous, self-paced modules that can be completed at your convenience. Do not complete this registration form unless you are committing to enrolling in Carthage's Act 20 Training.

The program fee is $800 and needs to be paid by credit card or debit card as part of this registration form.

For additional information about this program, visit the Carthage Act 20 Certification page.

How can we help? Contact us at admissions@carthage.edu or 800-351-4058.

Enrollment Information

Application for Enrollment In (Term/Year)

Personal Information

Prefix

First Name

Middle Name

Last Name

Suffix

Preferred First Name

Former Last Name(s)

Marital Status

Social Security Number (please skip hyphens and spaces; U.S. citizens only)

Your Social Security Number is required to receive a 1098-T. The 1098-T is a tax form issued by colleges to students, reporting tuition payments and related educational expenses that may qualify for education-related tax credits. We go to great lengths to protect the privacy of your personal information. Privacy Protection Policy

Birthdate and Birthplace

Birthdate

Birthdate

Birthplace Country

Birthplace City

Birthplace State

Country of Citizenship (Primary)

Country of Citizenship (Secondary/Dual)

Do you require an I-20 to attend Carthage? (form for international students)

Do you require an I-20 to attend Carthage? (form for international students)

Yes

No

Permanent Address

Permanent Address

Permanent Address

Country

Street

City

Region

Postal Code

Mailing Address

Mailing Address

Mailing Address

Same as Permanent Address

Country

Street

City

Region

Postal Code

Contact Information

Email Address

Primary/Personal Phone

Do you wish to receive text messages from Carthage?

Do you wish to receive text messages from Carthage?

Yes

No

Mobile Phone

Mobile Phone

.

Educational Background

DeleteCollege _ID_
List All Colleges Attended, Beginning With Most Recent
Please type the complete name of your college. If your school does not appear in the autocomplete field, simply submit it without the autocomplete. Level of Study College Name College CEEB (hidden) Country City State/Province Dates Attended (approximate): Start Dates Attended (approximate): Start Dates Attended (approximate): End Dates Attended (approximate): End Major(s)/Minor(s)

Add Another College

.

How did you first learn about Carthage?

Please explain:

Ethnicity / Religion

The following racial/ethnic background and religious identification responses are optional and are used for statistics. View Definitions

Are you Hispanic or Latino?

Are you Hispanic or Latino?

Yes

No

Racial Background (check all that apply)

Racial Background (check all that apply)

Religious Identification

Please explain

Signature

I certify that the information listed on this application is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any schools or colleges I have previously attended to release personal and academic information to Carthage. Further, I agree that my college grades may be used for statistical studies.

In place of your signature, please type your full legal name.

Registration Fee

The Carthage Act 20 Training registration fee is $800, which can be paid below by debit card or credit card.

Amount Due

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