School of Ed Info Event Bakersfield RSVP

To RSVP for the Bakersfield School of Education Information Event on:Thursday, May 23, 2013 at 6:00pm, please complete this form. We look forward to seeing you at our information event at the Bakersfield Regional Center, located at 5080 California Avenue, Ste. #300, Bakersfield, CA 93309.

First Name: *

Required

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Telephone Number: *

Email: *

How did you hear about our Info Event?: *

Billboard

Postcard Mailer

Bakersfield Voice

Word of mouth

PLNU Website

Email Flyer

*Radio

*Television

Other (Please specify):

*If you chose Radio or Television please specify below:

*Radio Station or Television Channel :

If you are currently a student, please indicate your year:

Undergrad-Junior

Undergrad-Senior

Post graduate

Other (Please specify):

Intended Start Date:

Summer 2013

Fall 2013

Spring 2014

Other (Please specify):

Please mark program(s) of interest:

M.A. in Teaching w/ Preliminary Credential:

Single Subject

Multiple Subject

Education Specialist Mild/Moderate or Moderate/Severe Disabilities

M.A. in Education, with concentrations in:

Teaching and Learning/Clear Credential

Educational Leadership

M.A. in Special Education:

Special Education/Clear Credential

Added Authorizations in Special Education:

Autism Spectrum Disorder

Traumatic Brain Injury

Other Health Impaired

Emotional/ Behavioral Disorders

Early Childhood Special Education Curriculum, Services and Supports

Service Credentials:

Administrative Services

Certificates:

Reading

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