Skip to Main Navigation | Skip to Content




TeacherLine Enrollment Form

1. Are you a U.S. citizen or permanent resident?*
2. Social Security Number
3. First Name*
4. Middle Initial/Name
5. Last Name*
6. Maiden/other name(s) used*
7. Address *
8. City*
9. County*
10. State*
11. Zip Code*
12. Country*
13. Home Phone*
14. Other Phone
15. E-mail Address*
16. Birthdate*
17. City/State of Birth*
18. Have you ever taken classes through UCM?*
19. Graduated with a Bachelor's from: (Name of school/college, State, Degree, Year)*
20. Name of PBS TeacheLine Course you enrolled for*
21. Full Course Number (i.e., MATH156.34)*
22. Please choose the course start date*
Fall - September 17, 2014
Fall - October 15, 2014
Winter - January 14, 2015
Winter - February 18, 2015
Spring - March 18, 2015
Spring - April 15, 2015
Summer - June 17, 2015
Summer - July 15, 2015