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Secure Online Enrollment Request Form
Welcome to VideoCourses4Teachers.com secure server enrollment request page. Please
fill out the registration form below to enroll in the courses of your choosing.
Be sure to fill out all fields before submitting your registration to
be processed. A confirmation will appear if your enrollment request is accepted.
For international enrollees there is an additional $25.00 per order shipping charge.
Payment accepted only by credit card in US funds. Videos available in DVD NTSC format
only. The DVDs will play in all territories but only on NTSC equipment.
Registration and Payment Information
Phone: If you have questions, please call us toll free at 800-486-8650 or direct at 310-823-5255 from 9AM to 5PM Pacific Time Monday thru Friday.
Online: Register using this Online Registration Form.
Mail: Print the online registration form on our website, complete it, and
mail with payment to Jim Thomspon, The Video Course, 4826 Patrae Street, Los Angeles, CA 90066.
Make checks payable to Quality Educational Programs, Inc.
Group Registration Instructions
To qualify for group discounts, all group members must register online on
the same day. In the Discount Code box on this online registration form, put GRP.
NOTE:
All fields in the form must be filled. If you are not currently teaching please put "N/A" in the appropriate boxes.
If you wish to enroll through Cardinal Stritch University, instead of using this
online registration form, please CLICK HERE FOR CSU.
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Personal Information
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| First Name
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First Name Required
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| Middle Initial
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Middle Initial Required
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| Last Name
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Last Name Required
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| Social Security # (last 4 numbers)
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SSN Required
(e.g.: XXX-XX-6789)
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| Date of Birth
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DOB Required
MM/DD/YYYY
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Billing Address
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| Billing Address
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Address Required
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| City
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City Required
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| State/Province
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State Required
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| Country
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Country Required
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| Postal Code
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Postal Code Required
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Shipping Address
Same as Billing Address
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| Shipping Address
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Address Required
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| City
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City Required
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| State/Province
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State Required
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| Country
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Country Required
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| Postal Code
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Postal Code Required
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Where You Teach
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| School Name
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School Required
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School Address
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School Address Required
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City
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School City Required
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State/Province
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State/Province Required
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Country
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Country Required
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Postal Code
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Postal Code Required
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School Phone
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(e.g.: 888-555-1212)
School Phone Required
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Home Phone
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Home Phone Required
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Home Email
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Home Email Required
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| Gender
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Gender Required
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Are you a U.S. Citizen or permanent resident?
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Required
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Are you of Hispanic or Latino/a ethnicity?
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Required
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Select one of the following racial categories that describe you:
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Required
Notice of Non-discrimination: The University does not discriminate on the basis of age, color, ethnicity, handicap, nationality, race, religion, or sex.
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| All materials will be shipped directly to your home address. International shipping
is available for an additional fee of $25 per order. For information call 800-486-8650.
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| Is your shipping address within the US?
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Shipping Information Required
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I am Enrolling with:
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University Required
Cardinal Stritch University
If you wish to enroll through Cardinal Stritch University, instead of using this
online registration form, please call the university directly at 414-410-4428 or
800-347-8822, Ext 4428.
*Drake University Credit
Drake University EDMA credits (Educational Masters) are considered transferrable and may be transferred into the following Drake University School of Education Program: Master of Science in Teacher Effectiveness and Professional Development.
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I am Enrolling in: (Maximum Courses*)
Please choose at least 1 course.
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*Maximum courses per term:
Andrews University 3 course limit.
North Dakota State University 5 course limit.
Cardinal Stritch University 3 course limit.
Drake University 6 course limit.
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All video programs are provided on DVDs.
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You can save almost $2,000 on your choice of two online Master
of Education degrees by transferring in credits earned in these courses. Would you
like us to send you more information on these degree programs?
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M.Ed. in Classroom Management:
This field is required.
M.Ed. in Differentiated Instruction:
This field is required.
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Regular Course Fee: $330 per course.
Early Bird Course Fee: $310 per course
Please see the home page for other discount information.
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How do you hear about QEP courses?
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Friend/Colleague
Print brochure
Email promotion
Search Engine (Yahoo, Google, etc.)
University web site
Facebook Advertisement
Other or can't remember
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I am a . . .
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If registering as part of a group, group leader's last name:
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Shipping and Handling
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All orders will be shipped First Class mail. A shipping and handling fee
of $6.00 will be added to all orders.
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Payment Information
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I understand and agree that with registering for the indicated course(s), I have obligated myself to pay for the course(s). If I later choose to withdraw from the course(s), I understand that a $35 per course administrative fee will be charge and I assume responsibility for officially withdrawing in writing to the university and returning my course materials by the prescribed date to Jim Thompson, The Video Course, 4826 Patrae Street, Los Angeles CA 90066.
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I Agree
You must Agree to our Terms by clicking this checkbox
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Review and Submit
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Please review your information to ensure the order is processed correctly. Thank you for your interest in our courses. Processing may take a few moments...
(PLEASE CLICK ONCE ONLY TO AVOID DOUBLE CHARGES TO YOUR CARD)
Copyright © 2011 Quality Education Programs, Inc.
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