WACE ASSESSMENT INSTITUTE REGISTRATION
    Each Registrant Must Fill Out Individual Form for Submission

(For Multiple Institutional Registrations, Payment May be Made As Single Payment for All Registrations
For Information please Contact Marty Ford)
       
    Primary Contact E-Mail Address:
    Click here if you DO NOT want your email address
to be listed on the Participants Roster
for the Institute
Do Not Use
    Is this your first WACE Event?
No
    How did you learn about this WACE event?
    Honorific
    Last Name:
    First Name:
    Job Title
    Institution Name:
    Institution Mailing Address:
     
    City:
    State / Province:
    Country:
    Postal Code:
    Telephone Number:
       
    QUESTION 1:
    What is your current level of knowledge of assessment of learning outcomes connected to CWIE: (check only one, please)
   
Just starting to learn Moderately knowledgeable Highly knowledgeable
     
    QUESTION 2:
    Is your program or institution currently engaged in the assessment of learning outcomes connected to CWIE?
   
Yes
    If yes, please choose one of the following levels:
   
Just getting started Midpoint in the process Fully implemented
     
    QUESTION 3:
    Does your program or college have a working group formed to work on the assessment of learning outcomes for CWIE?
   
Yes
    If yes, what is the makeup of the group? Please select all that apply:
   
Students Administrators Academic Administrators Senior Administrators
     
    QUESTION 4:
    Does your institution have an assessment person to assist you in your efforts?
   
Yes
     
    QUESTION 5:
    In general, what level of institutional support do you have for your efforts to conduct assessment of learning outcomes for your CWIE programs?
   
Good Excellent
     
    QUESTION 6:
    What are your top 2-3 learning goals for attending the WACE Assessment Institute?
    Goal1:
   
    Goal 2:
   
    Goal 3:
   
     
    Registration:
      Total: $ USD
    Payment Method
    ATTENTION: Payment by Credit Card REQUIRES ALL BILLING ADDRESS INFORMATION TO BE FILLED IN!
     
    Please Select Desired Form of Payment:
(See Instruction Below Regarding Payments)
       
    Credit Card Number (MasterCard or Visa Only):
    Expiration Date (mm/yyyy):
    Name on Card:
    Billing Address (if different from above):
     
    City:
    State / Province:
    Country:
    Postal Code:
       
   

World Association for Cooperative Education WACE
WACE Federal Tax ID # 04-3279172

If Paying by Check Send Registration Form and Payment to:
WACE
Suite 125
600 Suffolk Street
Lowell, MA 01854
USA
Attn: Marty Ford, WACE Director of Global Partnerships & Programs

Please make checks payable to: WACE

For Bank Transfer, please contact the WACE Secretariat for our banking information at
Marty_Ford@uml.edu