Name ______________________________ Date______ Semester (circle) Fall Spring
Address for all correspondence through May 25, 2007
Telephone
(_____)______________________email:_____________________________
University/College
Name___________________________________________________
Certification (circle)
ELE
SED
SPEC.ED
K-12
Application Fee: $20.00
Please make check payable to “Michigan
Association of Teacher Educators” and send to:
Dr.
Thomas Kromer,
Telephone: 989/774-3386
317
Ronan Hall, Mt. Pleasant, MI 48859
E-mail:t.kromer@cmich.edu