Academic Coursework Form Submission

Name (required)

Email (required)

Phone Number (required)

Address

City

State

Postal Code

RID #

Name of College/University

Course Title

Credit hours are (pick one): 1.5 CEUs per semester hour or 1.0 CEUs per quarter session
 Semester Credit Quarter Hours

Proposed Content Area (pick one)
 Professional Studies General Studies

Course Start Date

Course End Date

Note: Copies of College Transcripts must be provided. RID requires a grade of "C." Dr. Burch requires a grade of "B" or better.