ITJ On-Line Preregistration Form

ITJ Banner:  On-Line Preregistration Form

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Preregistering on-line is safe and easy. The on-line preregistration form is divided into two sections. The first section is for general information about those enrolling in the Institute. You will only need to complete this firm once. After preregistering, you can use your user name and password to review and change this information if needed.

The second part is where to sign up for a specific module or modules, select the category of credit you want, and enter your credit card information. The Institute's webserver is configured for secure credit card transactions. Please complete the following forms as completely as you can. If you have questions about completing the forms please call 1-800-300-8983 if you are in the United States, or 1-217-648-2353 if your are calling for another country. You can also send your questions by E-Mail to the
ITJ Administrator.

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First Name:
Initial:

Last Name:


Primary E-Mail Address:

(e.g., name@school.edu)

Home Address 1:


Home Address 2:


City: State:
;
or Province:
Postal Code:

Country:

(Click on the box and select the correct country from the list.)

Home Phone:
Home Fax:

Work Phone:
Extension:

Work Fax:


Social Security Number:

(If you are an American Citizen, your social security number will be used to verify changes to your registration or before transcripts are sent. If you do not have a Social Security number, please provide a unique identification number, that is no more than 10 characters in length, that can be used for verification purposes. Be sure to record this number so that you will be able to use it if needed)


I am a language teacher

I am a JALEX Mentor

I am a JALEX Assistant:

I am a college student studying to teach a foreign language:

School where you are a teacher or student:


If you are teaching, which grade levels do you teach? (Please select all that apply.)
Elementary
; Middle School ; High School ; Community College

Are you a native, or a non-native Japanese language speaker?

After submitting Section One of the Preregistration form, move to Section Two to select the module(s) you want to enroll in, pay the preregistration fee, and select a user ID.