EIU EDL -- Official MSED/EDS Course Request Form

Utilize this form to request to be enrolled into EIU EDL course(s) as part of a cohort, etc.

Please be sure to TAB through the form in order to reach the SUBMIT button for official submission.

* - Required fields

Semester:
Year:
E-Number:
Name: Name: First Last
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone: Cell Phone: - ### - ### ####
EIU Email:
Home Email:
Program:

Program: MSED Option #1 - Teacher Leader (33-hrs) MSED Option #2 - Principal (33-hrs) MSED Option #3 - Teacher Leader & Principal (42-hrs)

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EIU EDL -- Official MSED/EDS Course Request Form

EIU EDL -- Official MSED/EDS Course Request Form