* Indicates Required Field

*Last Name         *First Name        
*Middle/Maiden Name   
*Social Security Number     *Date of Birth    (example: 00/00/0000)
St. Thomas ID#    (Optional)
*Address           *City/State   
*Zip Code          *County       E-mail 
*Home Phone Number               Cell Phone Number         
*Gender    Choose Female Male

*Ethnicity         Choose One American Indian Asian Black Hispanic White      *Religion         Choose One Buddhist Jewish Orthodox Catholic Mormon Hindu Muslim Protestant(Baptist, Methodist, Lutheran, etc. Other
Information regarding the applicant's race or ethnicity is entirely voluntary and will be used in a nondiscriminatory manner, consistent with applicable Civil Rights laws.

*Name of Institution:                                                                          
     (List Only Colleges/Universities in which you have earned a Degree)
*City/State        

*Degree                      

*Month/Year Earned        

Name of Institution:                                                                   
     (List Only Colleges/Universities in which you have earned a Degree)
City/State

Degree

Month/Year Earned

*Dept:   Choose EDUC BIED *Course #   Choose 5311 5314 5325 5336 5338 5339 5364 5370 5380 5389   *Section   Choose PN PNA PNB  
Course Title    Day
 Professor       Location  

When you select submit, you will be taken to a screen with text on it. 

Your confirmation number will be your place number in the class.