2009 ADVANCED KELLOGG INSTITUTE APPLICATION

July 26 - July 31, 2009

Please print form, complete, enclose $100 nonrefundable deposit, and send to: 

Kellogg Institute, ASU Box 32098, Boone, NC 28608

Fax (828) 262-7183 --------- Phone (828) 262-3057, (828) 262-2805

DEADLINE FOR APPLICATION & PAYMENT IN FULL IS JUNE 1, 2009

-- Please Print Legibly or Type --

Name__________________________________________  Title________________________

Institution__________________________________________________________

Institution Address___________________________________________________

Institution City/State/Zip_______________________________________________

Home Address _____________________________________________________

Home City/State/Zip__________________________________________________

Institution Phone ____________________ Home Phone ____________________

Fax # ____________________________ Email Address ___________________

Kellogg Institute Class of ________

2009 ADVANCED KELLOGG INSTITUTE FEES

1. INSTITUTE FEE   $650.00
2. RESIDENCE HALL ROOM AND BOARD $224.00
3.

APPALACHIAN STUDENT ID (May be waived if you bring your APP ID card from previous Institute.)

+$15.00
4. TOTAL REQUIRED FEES $889.00
5.

OPTIONAL FEES FOR 3 HOURS GRADUATE CREDIT :   

HE 6541 - Seminar in Developmental Education / Strategic Learning in Developmental Education

 
Enter amount or N/A below:
  IN-STATE (NC) $ 519.13 ___________
  OUT-OF-STATE $1380.13 ___________
6. TOTAL ALL FEES   ___________
7. LESS $100 Non-Refundable Deposit

___________
8. BALANCE DUE: (by 06/01/09)   $__________

 

Explanation of Fees:  Institute fees cover all materials required for Institute sessions, faculty leadership, transportation to and from Charlotte International Airport, and the opening and closing dinners.  Residence hall room and board includes a single occupancy room, $65 meal plan, linens, internet, and local telephone service.

Please make checks payable to the Kellogg Institute. Wire transfers are not accepted.

You may pay your fees via Visa or MasterCard:

Visa________ MasterCard_______

Please specify: _____ Company Card _____ Personal Card

Credit Card Number_______________________________Expiration Date____________

Name on Card_______________________________Signature_____________________

Questions? Email kellogg@appstate.edu or hoffmankm@appstate.edu,
or phone (828) 262-3057

 

REV 04/15/09