(*) First Name:

(*) Last Name:

(*) Sex: M F

Home Mailing Address:
(*) Street Address:
(*) City:
(*) State: (*) Zip:

(*) Home Phone: (your home phone is required for registration)

(*) Personal, Year-Round E-mail Address: (Important: we will send all correspondence to this address. Please double-check spelling and enter ONE address only!)

(*) School Name (if not listed, select *** NOT ON LIST ***):
*** NOT ON LIST *** *** EL STAFF *** Academy of Learning and Leadership Adventure (Mapleton Elementary School #2) Adventure Learning Academy Alice B. Beal Elementary School Alternative Elementary II Amana Academy Anderson School ANSER Charter School Arbor Vitae-Woodruff Middle School Arlee Elementary School Arlee Junior High Aurora Xpeditionary Learning (AXL) Automotive High School Azleway Charter School Bastrop High School Bath Middle School Beaverton Science Academy Bronx Expeditionary Learning High School (BELHS) Bryant Elementary School C. S. Porter Middle School Calli Ollin Academies Cantwell School Capital City Public Charter School Casco Bay High School Cass Lake - Bena Area Learning Center Central Alternative High School Charter School 37 Chesapeake Academy Christa McAuliffe Regional Charter Public School City View Charter School Civano Community School Clairemont Elementary School Codman Academy Charter School Cooperstown Middle School Crabapple Middle School Decatur Discovery Academy Doris M. Johnson School Duggan Middle School E.L. Haynes Charter School East End Community School Entheos Academy Escuela Aurelio PŽrez Mart’nez Escuela Eduardo Garc’a Carrillo Escuela JosŽ A. L—pez Castro Escuela Juana Rodr’guez Mundo Escuela Ramiro Colon Colon Escuela Rexville Intermedia Escuela San Felipe Escuela Segunda Unidad Francisco Jord‡n Escuela Segunda Unidad Rogelio Rosado Crespo Escuela Superior Luis Mu–oz Rivera Escuela Superior Urbana Escuela Woodrow Wilson Evergreen Community Charter School Explore (Mapleton Elementary School #1) Fitchburg Arts Academy Four Rivers Charter Public School Frederick Douglass Preparatory School Grass Valley Charter School Hiddenbrooke Charter School HOPE High School - pre open Humanities Preparatory Academy Illinois Valley High School Inland Seas School of Expeditionary Learning J.A. Thompson Elementary John Stark Regional High School Kenosha Delta High School Kettle Falls Elementary School Lee A. Tolbert Community Academy Lee A. Tolbert High School Lighthouse Community Charter High School Lighthouse Community Charter School Lincoln Elementary Lincoln Middle School Manzanita SEED MESA (Skyview Expeditionary Learning Through the Arts) Methow Valley Community School Mile High Middle School Minturn Middle School Muffley Elementary School Newsome Park Elementary School Niagara Charter School North Routt Community Charter School Northpoint Expeditionary Learning High School Oakhurst Elementary School Parkside School Pastor Pauling Academy of Integrated Sciences Perrymont Middle School Pikes Peak School of Expeditionary Learning PIONEER School for Expeditionary Learning Pocatello Community Charter School Polaris Charter Academy Pottenger Elementary School Prescott Magnet School Profit Magnet High School PS/MS 27 Realms of Inquiry Red Canyon High School Renaissance Arts Academy Renaissance Expeditionary Learning Outward Bound School Reuther Central High School Rimrock Expeditionary Alternative Learning Middle School - REALMS Rio Gallinas Charter School for Ecology & the Arts RISE Community School Robious Elementary School Robious Middle School Rocky Mountain School of Expeditionary Learning Rocky Ridge Boarding School Roots and Wings Community Charter School Rose Linda Russell Byers Charter School San Luis High School San Rafael Middle School Santa Fe School for the Arts Sasha Bruce Public Charter School School of Engineering & Manufacturing at Edison Complex School Without Walls Middle School Schoolcraft Learning Community School Scuola Vita Nuova Public Charter School Sierra Vista SkyView Charter School Springfield Expeditionary Learning School St. Ignatius Middle-High School Summit School T. D. James Junior Academy Table Mound Elementary School Tapestry Charter High School Tapestry Charter School The Crossroads School The Genesee Community Charter School The Harbor Alternative High School The Harbor Alternative High School The James Baldwin School: An Expeditionary Learning School The Odyssey School The Silverton School of Expeditionary Learning Tri-Valley School Two Rivers Community School Two Rivers Public Charter School Urban Community Leadership Academy Urban Promise Academy Validus Preparatory Academy: An Expeditionary Learning School Valley View School Vergennes Middle School Vista Grande High School Washington Heights EL School Washington High School West Platte Elementary West Platte Jr.-Sr. High White Swan High School William Smith High School Winnequah Middle School Winnona Park Elementary School Wiscasset Middle School Wood Hill Middle School World of Inquiry-School #58

NEW SCHOOL INFORMATION:
(only needed if your school is NOT on the above list)

New School Name:

School Mailing Address:

School City, State, Zip:

School Phone:

(*) Your Position/Title:

(*) Grade Level(s):

(*) Content Area(s):

(*) National Institutes (choose ONE)

Check here if you will be taking the institute for college credit.

Housing

Check here if you are taking this course as an MOU Local spot (no housing required).

Please indicate any food allergies:

Please note any special needs we should be aware of:

Roommate Request:

(Note: For most courses, single rooms are not available. When single rooms are available we provide them for everyone on the course. We arrange double occupancy rooms for all other events.)

Fees / MOU Slots

(*) Select one:
My registration is covered by ELS contract (regular MOU slot).
I am a school principal, registering for one of our Principal Slots.
My registration is not covered by ELS contract: I will send the full payment upon acceptance of my application.

(*) Yes, I understand that in the event I need to cancel, I must fax or e-mail my cancellation at least three weeks prior to the start of the course. (FAX to 845-424-4280, e-mail to [email protected]). The school will be billed for $250 for any no-shows or cancellations within 3 weeks of the start of the institute unless ELS can fill the slot..