This agreement constitutes an intention to contract with the United Star Distance Learning Consortium (USDLC), Inc. for distance learning services to be delivered for a period of one year beginning (month) (year).

AUTHORIZED CONTACT
Check one:   Indiv School District Service Center Regional Office State
Name:		Title:
Phone:		Email:
Date:	(Format: dd/mm/yyyy)

LOCATION
Site Name: Address:

Mailing Address, if different:

City: State: State ** AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Site Coordinator *: Title:

Phone: Fax: Email:
*(Site Coordinator will receive User Name and Password confirmation by email for services selected. Reminder: Individual Registration needs to put their information as Site Coordinator to get User Name and Password)

SERVICES

We wish to enroll in the following:			FEES
1.		No Child Left Behind, Site License, $1000/building	$
2.		Literacy to Learn: Professional Development for 21st Century Educators
		a) $1000/building	$
		b) Individual Registration, $150/course/person Registrant Name: Email:
		(1) Elementary, $50/ person	$
		(2) Middle/Secondary, $50/ person	$
		(3) Digital literacy (K-12) , $50/ person	$
		(4) Scientific literacy (3-12), $50/ person	$
		(5) Best Practices for School Library Media Programs (video), $50/ person	$
		(6) Best Practices for School Library Media Programs (online modules), $50/ person	$
	(For multiple registrants, attach list of names and email addresses to accompany registration form.)
3.		Keynote Addresses "From the Experts" 1, $1000/building	$
4.		Keynote Addresses "From the Experts" 2, $1000/building	$
5.		Resources, $300/building	$
6.		Full Package #1-5 above, District $2500 plus $5/teacher; # of teachers =	$
7.		Full Package #1-5 above, Regional $2500 plus $2.50/teacher; # of teachers =	$
8.		Full Package Statewide, $5000 plus $1/teacher; # of teachers =	$
9.		ESL Courses
		a) Crossing Cultures, $350/individual, 4 CEUs	$
		b) Effectively Reaching English Language Learners, $200/individual, 2 CEUs	$
		c) Understanding English Language Learners, $200/individual, 2 CEUs	$
		d) Help! My Students Don’t Understand Me, $200/individual, 2 CEUs	$
10.		Online Course Development
		a) (Required for series) Develop and Teach Online Courses I: Introduction, $275/individual, 3 CEUs	$
		b) DATOC II: Develop Your Online Course, $275/individual, 3 CEUs	$
		c) Assessment: Assessing Students in Your Online Course, $200/individual, 2 CEUs	$
		d) Effectively Facilitating Online Collaboration, $200/individual, 2 CEUs	$
		e) Visual Design for Online Courses, $200/individual, 2 CEUs	$
		f) Learning Objects, $200/individual, 2 CEUs	$
11.		Books, Books, Books (K-5, 6-12), $400/building	$
12.		Science and the Living World (K-4), $150/person	$
13.		Bonus Programming eField Trips (No Charge) Science Multimedia Digital Library (K-12) (No Charge)
		Check/Purchase Order No.: Total Amount	$

Billing Information: Same as contact

Contact:	Phone: Email:
Mailing Address:

TERMS

I, , agree to disseminate the USDLC Site Code and Password to educators based on our registration level (by building, district, region or state) so they may access the USDLC Professional Development options selected with our subscription. I will also disseminate the name and email address for the locally assigned evaluator, required for all USDLC professional development programs. I understand that a rubric is provided within the evaluation process to support the supervisor in evaluating work and adding comments. Once the supervisor has approved the Webfolio Report of a course, I understand the participants will be notified by email and will be able to print out eCertificates of Course Completion. (Reference the CEUs and Graduate Credit section for full details.)

 

USDLC is a nonprofit, multi-state educational consortium committed to excellence in teaching and learning through blended technologies. USDLC is dedicated to ensuring that all students and educators, regardless of circumstance or geographic location, have equitable access to high quality education opportunities.