The following survey helps us keep our student database up to date.  The addresses provided will be used for official school communication and for partnering organizations membership information (AMI, AMI-USA, any applicable alumni org.).

Course Level *
Course Format *
Name *
Name
Please enter your legal first and last name here.
Please enter the first name you prefer.
Phone Number
Phone Number
Local Address *
Local Address
Please enter the address you will be staying at during the course.
Permanent Address
Permanent Address
Please list a permanent address, if different from the address listed above.
In Case of Emergency
Emergency Contact Person *
Emergency Contact Person
Phone *
Phone
Tuition and Cooperative Program Information
Tuition Payment *
Frequency of Payment *
Cooperative Program *
Other Montessori Diplomas/Certifications
Have you received any other Montessori training? *
What affiliation did the training center have?
Please enter a four digit year.
In order to comply with Oregon Administrative Rules associated with Private Career School licensure (OAR 715-045-0018 and 715-045-0064) and ODA Authorization (OAR 583-030-0042) , The Higher Education Coordinating Commission (HECC) requires Private Schools in the state to collect and report student level information to them. They will use the reported data to evaluate institution performance. All personal information collected from you will be kept secure in accordance with Oregon Identity Theft Protection Act (http://www.dfcs.oregon.gov/identity_theft/safeguard_data.html) . It will not be shared with anyone other than the State of Oregon.
Birthday *
Birthday
What is the highest level of education you've completed?
What is your preference for describing your ethnic origin?
Have you served on active duty in the US Army, Navy, Air Force, marine Corps, National Guard, or Coast Guard?