Hidden: Form Information

This form is for an individual who wants to sign up for VMP and pay individually.
CONNECTED TO production!

To test this form use:
https://modernclassrooms.tfaforms.net/266
https://modernclassrooms.tfaforms.net/266?tfa_632=LEARN
https://modernclassrooms.tfaforms.net/266?tfa_10=Referral%20-%20Cult%20of%20Pedagogy&tfa_632=PEDAGOGY

Discount Code

IPM Campaign

Step 1: Introduce yourself and choose a session

💵💲Payment is due upon submission of this form.💲💵 If you are enrolling and paying for yourself or someone else, please continue this form and enter your credit card details on the next page. If you are paying for someone else and you need an invoice to present to your billing department, choose the invoice option below and fill out the following details.

I would like to...

Invoice Details

Your First Name

Your Last Name:

Your Email Address:

Your phone:

Your Role:

Your Title:

Enrollee Information

⭐ Since you are enrolling someone else, you should complete all of the fields on this page with the enrollee’s information. ⭐

First Name

Last Name

Which is your preferred email?

WorkPersonal

Work Email

Personal Email

CALCULATED: Email chosen

What is your current job title? Please select the most applicable answer.

If you hold multiple roles, please select the role in which you are most interested in learning/applying the Modern Classrooms approach.

Please write in your job title.

What grade level(s) are you currently teaching? Please select the most applicable answer.

If you teach, coach, or plan to teach multiple grades, please select the grade level in which you are most interested in learning/applying the Modern Classrooms approach.

What content area(s) are you currently teaching? Please select the most applicable answer.

If you teach, coach, or plan to teach multiple content areas, please select the content area in which you are most interested in learning/applying the Modern Classrooms approach.

Please write in your subject area.

Do you currently work in the United States?

YesNo

Which best describes where you work?

School: I work directly for a school. This also includes charter schools, independent schools, religious schools, colleges or universities, behavioral centers, alternative schools, daycare centers, etc.District or Charter Network: I work directly or across multiple schools within a district or charter network.Other: I work for an Education Service District or nonprofit organization (e.g., BOCES, RESA, etc.).

In what city and state/territory do you work?
NOTE: For Manhattan, please enter "New York City." For Queens, please enter the neighborhood (e.g. Astoria, Flushing, etc.).

City Chosen

State Chosen

What is the name of your school?

Start typing keywords to filter the list of options.

School Chosen

What is the name of your district or charter network?

Start typing keywords to filter the list of options.

District/Charter Chosen

Please provide the name of where you work.

Start typing keywords to filter the list of options.

ESD or nonprofit chosen

Calculated: US Selection

US Account Name Chosen - will be used if they wrote in a new name. Otherwise ignored by connector.

Calculated: US AccountId Chosen - will be used in connector as Primary Affiliation. If it's blank, they must have written in a new account name.

If the calculated Id is blank, that means they wrote in either an independent school or a new nonprofit organization. Connector needs to handle this.

In which country are you located?

Do you work for a

School/University (I work directly at or for a school, college, or university. This also includes behavioral centers, alternative schools, daycare centers, etc.)District or School Administrative Service (I work directly for an entity that oversees a school or network of schools, including Ministries of Education or governmental agencies overseeing schools.)Other (Nongovernmental Organization, company, other non-school entity, etc.)

Country selected

Select the name of your school or organization.

Start typing keywords to filter the list of options.

HIDDEN: International selection

International Org ID Chosen

Calculated: International AccountId Chosen - will be used in connector as Primary Affiliation. If it's blank, they must have written in a new account name so that will need to be created, with the country in BillingCountry

Calculated: International Account Name Chosen - will be used if they wrote in a new name. Otherwise ignored by connector.

If new International org, what recordtype?

Calculated: OrgId or, if blank, will need to create an account

AccountId Chosen (if any)

Where Work Described

Select the session in which you would like to enroll

Session ID selected

Session Start Date

How did you hear about this opportunity to enroll in the Modern Classrooms (MCP) training? Please select the most applicable answer.

What was the name of the event?

Who referred you?

How you heard:

Payment Amount

Your total is $750.

The Virtual Mentorship Program costs $750. You’ve received the Cult of Pedagogy referral discount of $200, which brings your total to $550.

The Virtual Mentorship Program costs $750. You’ve received the Catlin Tucker referral discount of $100, which brings your total to $650.

The Virtual Mentorship Program costs $750. With your discount code, you save $150. Your cost is $600.

When you finish this form, you will be redirected to our enrollment form. You are not enrolled in the course until you complete the enrollment form.

When you finish this form, the enrollee will be emailed a link to our enrollment form. They are not enrolled in the course until they complete the enrollment form.

When you finish this form, we will send you an invoice via email within 5 business days. This invoice is due before the session begins and must be paid before we will send you the enrollment form, which you then may distribute to the intended enrollee.

I understand that I am responsible for paying the invoice to enroll an educator in the Virtual Mentorship Program before the session I chose begins. If I don’t pay the invoice, Modern Classrooms will withdraw the registration.

Would you be interested in connecting your school/district administration with someone from our team, to discuss ways that we might empower other educators in your community?

YesNoThis is completely optional, but we're always glad to make connections with school/district leaders.

Payment Details

Cardholder's Full Name

Cardholder's Email

Credit Card Number

Card Expiration (Month)

Card Expiration (Year)

Final Cost