Ending Global Racism Enrollment Form

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Enrollment Form - Committed to Ending Global Racism

Personal Information
Name * Required
First Middle Last
Title * Required
Institution/Organization * Required
Mailing Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address * Required
Enter Email Confirm Email
Professional Support
Please provide the name of the mentor or supervisor who is supporting your participation in the program, if any.
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Institution/Organization
Phone Number
Email Address
Payment
Please indicate who will be paying the program cost: * Required
- Applicant
- Institution
Please select your institution/organization's membership status. * Required
- Forum Member
- Non-Member
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Have you attended any Forum Webinars since July 2020? * Required
- Yes, I have participated in an Ending Global Racism webinar.
- No, I have not participated in any Ending Global Racism webinars.
- Maybe, I am unsure. Please review my record.
The Forum will review your record to determine if any of the webinars you have previously participated in qualifies towards this program.
Enrollment Agreement
I attest that I have downloaded and read the Enrollment Agreement. I accept the policies and procedures related to The Forum on Education Abroad's Credential Program and all its provisions included in the Enrollment Agreement. * Required
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Read the Enrollment Agreement that applies to all Forum credentials and digital badges
Non-Native English Speakers
- Please check if you are a non-native English speaker.
Disability
- I have a physical, sensory, psychiatric or learning disability and am interested in discussing accommodations necessary to participating in this program.
Participants bear the responsibility of initiating a disability-related notification. Check the box if you have a documented disability that needs to be disclosed as part of your participation in the program. You will be contacted confidentially to discuss your needs.
By my electronic signature below, I agree with and accept these provisions. * Required
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Privacy Policy * Required
- I give my consent for The Forum on Education Abroad to collect and use the information provided in this form as outlined in their Privacy Policy
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Enrollment Form - Committed to Ending Global Racism

Personal Information

Professional Support

Payment

Enrollment Agreement

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