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  OnLine ALI Course Registration Form 

ALI Course Registration
* = Required Fields
Last name
First name
Birthdate and/or
E-mail address
Address 1
Address 2
Zip/Postal Code
Mobile phone
Fax number
Bachelor's degree is in
Institution granting Bachelor's degree
Highest academic degree earned
Year degree granted
Check the course(s) for which you are enrolling:

Act 48 number (for Pennsylvania teachers only)
I paid electronically by:

Date the electronic payment was made:
Cancellations: A $50 processing fee will be assessed for cancellations. The remainder of the registration cost will be refunded.
Submit Form 


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