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 CreditQuarter Hours

    Proposed Content Area (pick one)
    Professional StudiesGeneral 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.