HSPA Standards-Based Workshops

Registration Form

To reserve a space in a workshop, send in this Registration Form promptly; do not wait for your district to submit materials for you.

 
First Name: _______________________  Last Name: ________________________________

Home Address: __________________________________________________________________

City: ____________________________________________  State: _____  ZIP: _________

Home Phone: ________________________

Email: _________________________________________________________________________

Grade(s) Taught: _______________________________________________________________

School: ________________________________________________________________________

School Address: ________________________________________________________________

City: ____________________________________________  State: _____  ZIP: _________

School Phone: ________________________

School Principal Name: _________________________________________________________

Math Supervisor Name: __________________________________________________________

Please enter the workshop code, location, and date for each workshop you would like to attend.

 
   Code       Location                                   Date

1. _________  _________________________________________  ___________

2. _________  _________________________________________  ___________

3. _________  _________________________________________  ___________

4. _________  _________________________________________  ___________

   Total workshop registrations _____ x $185 = __________ total due.

Payment method:

 
[ ]Purchase Order  [ ]Check

Send this form with payment ($185 per workshop, payable to "Rutgers University - HSPA Workshops"), to:

HSPA Workshops
SERC Building - Room 221
Busch Campus
118 Frelinghuysen Road
Piscataway, NJ 08854-8019

Call us at 732-445-4065 or email programs@dimacs.rutgers.edu if you have any questions.

Registration Information

  • To register for workshops, print this page, then complete and mail in the Registration Form.
  • Please print a different form for each registrant.
  • The cost is $185 per workshop (including continental breakfast and lunch).
  • Enrollment is limited and applications are accepted on a first-come, first-served basis.
  • Enclose payment for the appropriate amount with your Registration Form. Checks and Purchase Orders should be payable to "Rutgers University - HSPA Workshops."
  • We must receive your registration form and payment information one week before the date of the first workshop for which you are registering.
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