Request Info

An information packet will be mailed to you within 3-5 business days. It will include a thorough overview of the program, financial aid information, course curriculum, addmissions checklist and other pertinent information. 

Your information will not be shared with outside parties.


First Name: *
Last Name: *
Home Address 1: *
Home Address 2:
City: *
State: *
Zip Code: *
Home Phone: *
Cell Phone:
Email Address: *
Re-Type Email Address: *
District Name (if applicable):
Employer's Name:
Occupation:
Grade Level (if applicable):
If you are interested in having a ME-PD Learning Community run in your area, please indicate the city/town and state:
Semester you are interested in enrolling: *
How did you hear about the ME-PD Learning Community graduate degree program? (Check all that apply) *
 Brochure
 Email
 Website
 Post card
 Flyers in teacher's lounge
 Conference
 Newspaper
 Word of Mouth
 Friend in, or graduate of program
 Seen Magazine
 Seen Website
 Other (please enter in the next area)
Please describe (for Other)
Questions/Comments:
Year you are interested in enrolling: *