Soutwest Center for Accelerated Schools Powerful Learning

Southwest Center for Accelerated Schools ELITE Enriching Learning by Investing in Teacher Excellence
University of Texas at Austin

Powerful Learning Institute

Registration Form

(To download this form: right-click one of the following: MS WORD, PDF and "Save Target as...") Email to: acceleratedschools@austin.utexas.edu or fax to: (512) 232-0707.

Name _____________________________________________________________________________

Campus ____________________________________________________________________________

Address __________________________________________________________________________

School Phone Number (____)___________________ School Fax Number (____)____________________

Grade Level Assignment/Subjects ________________________________________________________

Home Address ______________________________________________________________________

E-Mail Address _____________________________________________________________________

Home Phone Number (____)____________________ Cell Number (____)_________________________

	____ Central: San Antonio, Texas – Park Village Elementary, Judson ISD June 11-14, 2007 Contact: Norman Poole npoole@mail.utexas.edu
	____ East : Houston, Texas – Raul Yzaguirre School for Success July 16-19, 2007 Contact: Johnnie Brown jlbrownf@mail.utexas.edu
	____ Rio Grande Valley : Alamo, Texas - North Bridge Elementary Weslaco ISD July 23-26, 2007 Contact: Paul Rudnik prudnik@mail.utexas.edu

Registration fee $265.00 per participant of fiscally current and continuing schools.

Registration fee $425.00 for all other participants. Fees include all duplicated materials, continental breakfast, afternoon snack,the Differentiated Classroom: Responding to the Needs of All Learners book.

Participants are responsible for all travel arrangements

Method of Payment-Payable to University of Texas at Austin,
Check/Money Order _______________________________
Purchase Order # _________________________________

District/Campus Billing Information:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________ Refund policy: Registration fees are non-refundable. (Substitutions are accepted.)

Please mail or fax this form to:
Deborah Perez Accelerated Schools Elite
University of Texas at Austin College of Education
4030 W. Braker Lane, Ste. 2, Rm. 243
Austin, TX 78759

Phone: 512-232-0700
Print this form and fax to: 512-232-0707
OR download this form and E-mail to: acceleratedschools@austin.utexas.edu