CASE Pre-Service Application

CASE Pre-Service Application

Application Periods

Fall semester: May 15th - July 15th
Spring semester: Oct 15th - Dec 15th

Review the CASE Host Manual and Pre-Service Addendum before completing this application. All prospective affiliate institutions must be able to meet the requirements specified in the CASE Host Manual if they are chosen as a host site.

NOTE: You must submit a separate application for each course or institute you wish to host.

Please submit at least 60 days before your institute.

Host Contact Information

Organization/Institution*

Primary Contact: First Name*

Primary Contact: Last Name*

Primary Contact: Title*

Primary Contact: Email Address*

Primary Contact: Cell Phone*

Secondary Contact Information: This should be an individual capable of implementing the event should the primary contact become unavailable.

Secondary Contact: First Name*

Secondary Contact: Last Name*

Secondary Contact: Title*

Secondary Contact: Email Address*

Secondary Contact: Cell Phone*

What is this person's role?*

CASE Institute Information

Which course would you like to offer for your CASE Institute?*

Select

What CASE Institute format will be implemented?*

Pre-service - traditional

This will be a traditional institute which will be conducted on consecutive days (not including weekends)

Pre-service - integrated

This model involved incorporating the institute into a semester-long course.

Select

Lead Teachers*

Please let us know who will teach at your institute and if CASE will be processing the payment for that lead teacher.

Select

Pre-Service Start Date*

Pre-Service End Date*

Billing Information

Will there be a cost to your pre-service students?*

Please select no if the college or university pays for the pre-service certification.

Once all students are registered, an invoice for the certification fee will be sent to the billing contact below.

Please remember that:

For CASE Institutes, the pre-service certification fee is $500.
For BriefCASEs, the certification fee is $200.

Yes

Cost

Billing Name*

This would be the Organization/Institution.

ATTN:*

Billing Address*

Billing City*

Billing State*

Billing Zip*

Phone Number*

Registration Process

Once your application is processed, CASE sends you a registration link. All students must create a MyCASE account and register for the institute using that link.

Signature and Date for Agreement

Agreement*

Please type your name below if you agree to pre-service expectations in the CASE Host Manual and Pre-Service Addendum.

Today's date*

Review and Print Your Application - Please verify the information you provided. At the bottom of the page, there is a checkbox to receive an email copy of your application. If you would like a copy, please check the box to indicate you would like to receive a copy of your response. Thank you!

Send me a copy of my responses

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