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Summer Institutes for Educators Course Enrollment Form
University of the Pacific, Benerd College
General Information
Legal first and last name:
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Middle Initial:
Preferred First Name:
Street address:
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City
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State
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Zip code
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Personal/Home Email Address:
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Phone number (numbers only)
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Date of birth
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Have you previously attended Pacific?
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Yes
No
Year attended
Name while you attended
Student ID number:
Subject taught
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Grade level:
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School:
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School district:
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How did you find out about this class?:
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Course Registration
Please choose the course you would like to register for from the drop down menu:
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On Demand National Course: PDSI 9970 Are You At Your Best? Empowering (At-Home) Students to Self-Manage 3 units
On Demand National Course: PDSI 9970 Are You At Your Best? Empowering (At-Home) Students to Self-Manage 4 units
Please select your preferred grading option
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Letter Grade (A-F)
Pass/No Credit (P/NC)