IC3 Training & Certification course
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Free IC3 Training for K-12 Teachers - Application Form

Applying for your free IC3 training is easy! Simply follow the steps below:

1. Complete and submit the application form below.
2. An Authorization Form will be e-mailed to you.
3. Print the Authorization Form and obtain a signature from your school's principal.
4. Fax your signed Authorization Form to 301-656-0177.

Fields marked are required. Please do not abbreviate the name of your school and school district.
E-Mail Address (school):
E-Mail Address (personal):
First Name:
Last Name:
Dept./Grades Taught:
Name of School:
Name of School District:
School Address Line 1:
School Address Line 2:
City:
State:
Zip/Postal Code:
Country:
School Phone: Ext.
Alternate Phone:
Comments:
How did you hear about this free training program? (Please select all that apply)
Colleague
Principal/Supervisor
Another School:
Internet Search
Trade Show/Conference:
Publication:
Received Postcard
Other Request (Please specify):