BRL: Braille Through Remote Learning
Intro to Braille
Registration Form

STUDENTS REGISTERED BEFORE 1 OCTOBER 1999 -- READ THIS BEFORE REGISTERING

This form lets you register for the INTRODUCTION TO BRAILLE course.

Please use other forms to register for other courses:

Braille Transcribers Course
Specialized Codes Course

For more information, contact Ronald Broadnax (rbroadnax@shodor.org).

NOTE: it is especially important that you fill in the boxes with "who you are" types of information. This includes your name, you email address correctly entered, your Web page address (if you have one), your title and institution name (if you are an educator), and address.

Please fill out the form and press "Register" when you are finished.

Enter contact information:

Name:

Phone Number:

Fax Number:

E-Mail:

Address:

Are you a:

Institution Name:

NOTE: the following questions refer specifically to teachers and educators:

Position:

Type of Institution:

Highest Degree:
BS/BA
MS/MA/MSEd
PhD/EdD

Years of Teaching Experience:
1-5
6-10
11-15
More than I care to count (>16)

Describe your PRIMARY academic responsibilities:
Teaching
Research
Administration
Other (describe below)
Add comments here about your academic responsibilities:

The following questions are directed at all participants:

Years of Technology Use Experience:
1-5
6-10
11-15
More than 16

Describe the hardware that you will use for this course (note: select the one that you will use most regularly):
Macintosh
IBM/Windows
UNIX Workstation
Other (describe below)

Add comments here about your hardware:

Describe your Web connection (note: select the one that you will use most regularly):
Dialup SLIP/PPP
America Online
ISDN
T1/T3
Other (describe below)

Add comments here about your connection:

Describe your previous brailling background (coursework, workshops, experiences, etc.

Other comments:

NOTE! SUBMITTING THIS FORM IS YOUR AGREEMENT FOR YOUR EMAIL TO BE ADDED TO OUR EMAIL MAILING LIST! We do not SELL this list. We use this list to communicate with you about matters related to the BRL program. If you do not want your email address on this list, do not submit this form!

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Developed by

The Shodor Education Foundation, Inc.

BRL: Braille through Remote Learning

BRL: Braille Through Remote LearningIntro to BrailleRegistration Form

BRL: Braille Through Remote Learning
Intro to Braille
Registration Form