Name __________________________________________________________________

Institution _______________________________________________________________

Institution Address ________________________________________________________

Institution Phone (     ) ____________________ Fax (     ) ______________________

Kellogg Institute Class of _______

Home Address ___________________________________________________________

Home Phone (     ) ________________________ E-mail_________________________

Your areas of interest for action plan: ________________________________________________________________________

________________________________________________________________________

2007 Advanced Kellogg Institute Fees:
Institute Registration ……..…………….$550.00
Room and Board ………………………$229.30
Total Required Fees …...………………$779.30

Optional fees for 3-hours graduate credit
In-state ………………………………...$ 465.13
Out-of-state ……………………………$1224.13
Appalachian State University
TOTAL OF ALL FEES ..……………...$______
Less $100.00 deposit ………….............. -100.00

BALANCE DUE by June 1, 2007…..…$______
(Mastercard/Visa will be accepted for balance of fees)

This application must be returned to the Advanced Kellogg Institute no later than June 1, 2007. Please mail application and nonrefundable deposit to:  National Center for Developmental Education, Reich College of Education, ASU Box 32098, Boone, NC 28608.

Please make checks payable to the Kellogg Institute.