|
|
|
|
|
Enter Registrant ID
Apostroph is not allowed in Registrant ID
|
Please enter a registrant ID composed of your first initial, last initial (both lower case) and the last six digits of your social security #. You may choose any password up to 10 characters in length for security.
|
|
|
Enter Password
Password can contain letters, numbers and the following symbols: !@#$()
|
Required
|
|
|
Enter confirm PasswordPassword don't match
|
Required
|
|
|
|
|
|
|
|
|
|
|
|
Enter First Name
Numbers not allowed in First Name
Text 'First Name' not allowed
|
Name must appear exactly as on certification.
|
|
|
Enter Last Name
Numbers not allowed in Last Name
Text 'Last Name' not allowed
|
Required
|
|
|
professional id should be numeric. professional id should contain 7 digits.
|
Required in order to process Act 48
|
|
|
|
Required
|
|
|
|
Enter Work Phone area code
InvalidWork Phone area code
|
Enter Work Phone prefix
InvalidWork Phone prefix
|
Enter Work Phone suffix
InvalidWork Phone suffix
|
Invalid Value in Work Phone Extension
|
|
|
|
|
|
Required
|
|
|
|
Enter Home Phone area code
InvalidHome Phone area code
|
Enter Home Phone prefix
InvalidHome Phone prefix
|
Enter Home Phone suffix
InvalidHome Phone suffix
|
Invalid Value in Home Phone Extension
|
|
|
|
|
|
Optional
|
|
|
|
InvalidFax area code
|
InvalidFax prefix
|
InvalidFax suffix
|
Invalid Value in Fax Extension
|
|
|
|
|
Enter Email Preference
|
Required
|
|
|
Enter Address1
|
Required
|
|
|
Enter City
|
Required
|
|
|
Please select State
|
Required
|
|
|
Enter Zip
Zip is not valid.
|
Required
|
|
|
Enter Primary Email
Primary Email should be in proper format.
|
Required
|
|
|
Confirm Primary Email should be in proper format.
Re-enter Primary Email
The Primary Email and Confirm Primary Email fields must match.
|
Required
|
|
|
Please select District
|
Required
|
|
|
Please select Building
|
Required - Name of School
|
|
|
Please select County
|
Required
|
|
|
Enter Position Description
|
Required
|
|
|
Please select Grade
|
Required
|