* 1. Registrant Information:

* 2. My job title is:

* 3. Which of the following describes the evaluation carried out by your organization? (check all that apply)

* 4. Does your job require you to conduct program evaluation?

* 5. Are you in a position to determine whether and what kind of evaluation will be conducted within your organization (which may include determining allocation of resources to evaluation)?

* 6. How would you characterize your evaluation background?

* 7. What is your primary goal in attending this conference (i.e. what are you hoping to gain?)

* 8. Is there anything else you’d like us to know?

* 9. Are you an alumnus of Montclair State University?

* 10. If Yes, please indicate the most recent year you graduated and your program/major.

BEFORE HITTING THE "NEXT" BUTTON BELOW, PLEASE PRINT OUT THIS PAGE SO THAT YOU MAY MAIL THE PRINTOUT TO COMPLETE YOUR REGISTRATION.

Please include a check or money order (see fee schedule below) made payable to Montclair State University and mail to:

Ms. Tina Seaboch
Center for Research & Evaluation on Education and Human Services
UN3124
Montclair State University
1 Normal Avenue
Montclair, NJ 07043

Forms and payment must be postmarked NO LATER THAN September 25, 2012. If you have any questions, please email Ms. Seaboch at seabocht@mail.montclair.edu


WORKSHOP FEE SCHEDULE (includes tuition, materials, continental breakfast, lunch, and parking):

Postmarked by August 30:
$200 individual registration
$125 for each additional individual from the same organization

Postmarked between August 31 and September 25:
$ 250 individual registration
$150 for each additional individual from the same organization


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