University of Louisville APSI 2015 Registration

Please complete the entire registration form. Registration is not guaranteed until full payment is made. Full payment or a purchase order is due by April 30th for APSI Session I and by May 30th for APSI Session II to avoid the $45 late fee. A purchase order number included on the registration form secures space at the institute. Class placement will be accepted on a first-come, first-serve basis. Expect an email to verify that your registration was submitted. Contact us immediately if you do not receive an email. We look forward to seeing you this summer!

First Name

Last Name

Home Address

City

State

Zip

Home phone number xxx-xxx-xxxx

Cell phone number xxx-xxx-xxxx

Emergency Contact Full name

Relationship to emergency contact

Emergency contact phone number xxx-xxx-xxxx

Your E-Mail Address

Confirm E-Mail Address

High School

School Address

City

State

Zip

School phone number xxx-xxx-xxxx

School fax number xxx-xxx-xxxx

Teaching position

School affiliation

Public
Private
Parochial

Years of teaching experience

Years teaching AP classes

Will you teach an AP class next year?

Yes
No

Will you be staying in On-Campus Housing? Cost is $250 for lodging Sunday-Friday. Full payment by cash, check, credit card, purchase order, or money order is due to the UofL APSI business manager on the first day of the institute. Cancellations must be made by June 1 or you will be billed the full cost. To cancel, e-mail apsi@louisville.edu or call 502-852-8110.

Yes
No

Special needs: e.g. physical disabilities or dietary restrictions

Class selection Session 1 (June 15-19, 2015)

Class selection Session 2 (July 20-24, 2015)

Method of payment Registrations are accepted on a first-come, first-serve basis. Your space will not be reserved until you or your school district have submitted full payment. A $45 late fee will be charged after registration deadline. NOTE: If paying with a credit card, do NOT hit the back button as it could duplicate the card processing.

Amount: All fees include packets, training materials, breakfast, lunch and snacks Please select according to session selection

$550 (all classes EXCEPT Biology, Chemistry, Computer Science, Environmental Science, Physics 1&2)
$600 (includes lab costs: Biology, Chemistry, Computer Science, Environmental Science, Physics 1&2 includes lab costs)

Please enter a PO number

Contact person (PO only)

Contact address (PO only)

Contact phone # (PO only) xxx-xxx-xxxx

Contact e-mail (PO only)

Thank you for registering for the UofL AP Summer Institute. For payment questions, email apsi@louisville.edu. Please make checks payable to the University of Louisville and mail to:

Advanced Placement Summer Institute

Attn. Jeanne Guerrero

University of Louisville

2211 South Brook Street

Houchens Building, Suite 150

Louisville, Kentucky 40208

* College Board certificates of completion will be mailed to your home address after the institute ends and once your balance is paid in full.

Office of Admissions

University of Louisville APSI 2015 Registration