Application | Mountain West Center

*Name

First, Last

Preferred Name

Indicate Preferred Name (if different from above)

USU A#

(if known)

*Email

*Mailing Address

*City

*State

*Zip Code

*Phone Number

*Current School / Teaching Position

*Teaching Experience

Briefly describe your teaching experience (current degree seeking students please include degree program, expected graduation date, credits completed).

*Reason for Enrolling

Briefly describe (around 100 words) why you wish to take this course with special attention given to how this year's theme is applicable to your (future) career.

*Course RequestChoose the course for which you plan to register

*Number of Credits or UnitsChoose the number of credits or units for which you plan to register

1 credit / 1.5 CEUs

2 credits / 3.0 CEUs

3 credits / 4.5 CEUs

*Dietary or Physical Needs

Please list any requirements for dietary needs, food allergies, or physical accommodations..

*How did you hear about the workshop?

Please let us know how you heard about the workshop to help us better get the information to those with interest. Thank you!

Bennion Teachers' Workshop Application Form