E-learning Center K-12 Registrations

Please complete the following form accurately.
* Indicates a required field.

Click the "Submit Data" button at the bottom of this page after completing the form.

             
     School Information:
     District: (Your district not listed? Fill in "Other" below.)
     Other:
     Mailing Address:*  
     Mailing Address:
     City:*  
     Zip Code:*  
             
     School Administrator:
     First Name:*  
     Last Name:*  
     Phone #:*  
     Fax #:
     E-mail:*  
             
     Contact Person:
     First Name:*  
     Last Name:*  
     Phone #:*  
     Fax #:
     E-mail:*  
             
     E-mentor assigned by your district for your DDN receiving site:
     This year we are requiring that participating schools provide information for each e-mentor that will provide in-class support in the upcoming school year. At least one record is required to continue.      
 
E-mentor record required. Please click the "Add E-mentor" button to add E-mentor Information.
   
           
             
     District Network Administrator:
     First Name:*  
     Last Name:*  
     Phone #:*  
     Fax #:
     E-mail:*