The Pennsylvania Association of Colleges and Teacher Educators

A State Unit of the Association of Teacher Educators
and The American Association of Colleges for Teacher Education

 

MEMBERSHIP APPLICATION
July 1, 2011 through June 30, 2012

TITLE	Dr. Ms. Mr. Mrs.
LAST NAME
FIRST NAME
MIDDLE INITIAL
PREFERRED ADDRESS FOR MAILING:	Home Institution
HOME ADDRESS: STREET
CITY
STATE
ZIP
HOME PHONE
E-MAIL ADDRESS
It is imperative that PAC-TE has your e-mail address if you want to receive updated information electronically. Many materials are sent only electronically.
INSTITUTION AFFILIATION
ADDRESS
ADDRESS
CITY
STATE
ZIP
WORK PHONE
FAX NO.
TYPE OF MEMBERSHIP	PAC-TE Regular $50.00 PAC-TE Student $20.00 PAC-TE Retired $20.00 Special! PAC-TE First-year membership $30.00
PRIMARY FOCUS GROUP (choose one):	Social and Psychological Foundations Early Childhood Certification C&I Middle Level Certification C&I Secondary and K-12 Certification C&I Special Education Field Experiences and Supervision Policy and Program Administration Post Baccalaureate/Graduate Educational Leadership
SECONDARY FOCUS GROUP (choose one):	Social and Psychological Foundations Early Childhood Certification C&I Middle Level Certification C&I Secondary and K-12 Certification C&I Special Education Field Experiences and Supervision Policy and Program Administration Post Baccalaureate/Graduate Educational Leadership
ARE YOU A MEMBER OF THE ASSOCIATION OF TEACHER EDUCATORS?	YES NO

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Complete the membership application and mail, with your check payable to PAC-TE, to:

Ms. Linda Cook
5730 Sherrod Hill Road
Edinboro, PA 16412

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