CTER Suppliemental Form

Supplemental Form for Admission to the Online Master of Education in Curriculum, Technology, and Education Reform

Please complete the following information. Click on the Submit Supplemental Form button at the bottom when you are done.

For the extended response questions, you may want to type your responses into a text editor (such as Notepad on Windows or SimpleText on the Mac) on your own computer, save it, and then copy and paste the text into this form, in case you lose your connection before sending the application. DO NOT COPY AND PASTE FROM MICROSOFT WORD. If your information is already in Word format, please paste it into Notepad first, then copy and paste from there. The special formatting characters used by Word often create problems when used with other software.

* = required information

Your Name: *

Address: *

City: *

State: *

Zip: *

School Phone: *

Home Phone: *

Fax:

Email: *

Personal URL:

School: *

District: *

Current Job Responsibilities: *

Please describe your experiences with technology. Also, please describe the technology courses or workshops you have taken, software & hardware you have used, and the technology you have used or would like to use in your classroom. *

List three references who can attest to your use of technology. Include their email addresses and telephone numbers.

Reference 1: *

Reference 2: *

Reference 3: *

Have you read the General Information sheet that describes the program requirements and expectations of the participants? *

Yes
No

Do you have access to the Internet from BOTH home and school? *

Yes
No

How did you learn about the CTER program? *

Conference
Brochure
Colleague
CTER Web Site
University of Illinois Website
UI Online
Illinois Virtual Campus
Peterson's Guide
Sloan-C Catalog of Online Educational Programs
Gradschool.com
Other

If you selected OTHER, please specify:

* = required information