APPLICATION & FEES - 2010 KELLOGG INSTITUTE

Please print form, complete and return to:  Kellogg Institute, ASU Box 32098, Boone, NC 28608. Fax (828)262-7183

Important - APPLICATION PACKAGE MUST INCLUDE: 
  1. An application form completed in full -- INCLUDING FEES WORKSHEET,
  2. A non-refundable $250 deposit, AND
  3. A brief statement of your objectives for attending the Kellogg Institute.

Notification of acceptance will be made upon receipt of the application package.

APPLICATION (All fields required - Please PRINT legibly or TYPE):

Mr.____ Mrs. ___ Ms. ___ Miss ___ Dr. ___

Name__________________________________________  Title________________________

Preferred Name ____________________________

Institution__________________________________________________________

Institution Address___________________________________________________

Institution City, State, Zip ______________________________________________

Home Address _____________________________________________________

Home City, State, Zip

Institution Phone ____________________ Home Phone ____________________

Cell Ph # _________________________ Preferred Email Address ___________________

(please make sure your e-mail client is set to accept mail from kellogg@appstate.edu)

Type of Institution:  Public ___ Private ___ Two-year____ Four-year ___

Please check all appropriate position(s) you hold:  Administrator___ Counselor ___

    Instructor ___ Other (please specify)________________________________

Number of years you have been in Developmental Education ________

Major responsibility/roles within last five year: ______________________________

_________________________________________________________________

How did you learn about the Kellogg Institute?_______________________________________

Email questions to kellogg@appstate.edu or hoffmankm@appstate.edu
phone (828) 262-3057 or fax (828) 262-7183

Please Note: Kellogg Institute Applicants must also apply to Appalachian State University's Graduate School as non-degree students. A separate application fee of $50 is payable to the ASU Graduate School upon completion of that application. Directions for completing the graduate school application will be provided upon acceptance into the Kellogg Institute. Contact us at the e-mail or phone number below if you would like more information regarding this requirement.

2010 KELLOGG INSTITUTE FEES WORKSHEET

IMPORTANT: These figures are for use in estimating cost of attendance. Fees indicated with an asterisk (*) are 2009 fees and are subject to an increase of approximately 5% - 7%. 2010 tuition and fees will be updated as soon as they are available. Participants accepted into the Kellogg Institute will be invoiced for 2010 fees. This worksheet must be included with your application so that we can invoice you appropriately.

REQUIRED FEES:

1. INSTITUTE FEE   $1487.00
2. RESIDENCE HALL ROOM AND BOARD (est.)* +$1051.50
3. SUPERVISED PRACTICUM:    Participants must enroll in HE 6900 (3 cr.) to cover practicum supervision. (enter amount below)  
  IN-STATE TUITION/FEE* $ 519.13* _______
  OUT-OF-STATE TUITION/FEE* $1380.13* _______
4. TOTAL REQUIRED FEES (est.) ______
5. OPTIONAL GRADUATE CREDIT TUITION AND FEES

(SEE BELOW **)

  
  IN-STATE*

$173 per credit hour*

______
  OUT-OF-STATE*
$460 per credit hour*
______
  SGA Fee * $ 0.12* ______
6. TOTAL ALL FEES:
(est.)
 $_______
       
7. LESS $250 Non-Refundable Deposit (enclose with application) - $250.00
8. BALANCE DUE: (by 4/15/10)
(est.)
 $______


**OPTIONAL GRADUATE CREDIT FEES WORKSHEET: Additional graduate credit for the summer seminars is optional. 3 to 6 hours of credit may be earned by enrolling in HE 6090 (3 hours) - Seminar in Adult and Developmental Education and/or HE 6631 (3 hours) - Teaching and Learning in Postsecondary Education.

If no graduate credit is desired, do not complete this section:

HE 6090 - Seminar in Adult and Developmental Education   (3 hours) ____ Hours
HE 6631 - Teaching and Learning in Postsecondary Education (3 hours) ____ Hours
Total # ____ Hours

Summer Tuition:* Multiply total graduate credit hours by rate:

In-state = $173* per hour x ________Hours = $_________
Out-of-state = $460* per hour x ________Hours = $_________
Total Optional Fees:
(place this amount in section 6 above) (est.) $_________

THE BALANCE OF ALL FEES IS DUE APRIL 15, 2010.

Explanation of Fees:  Institute registration fees cover all materials required for Institute sessions, faculty leadership, ASU photo ID card, and the opening and closing dinners.  Residence hall room and board includes a single occupancy room (with shared bath) and meal plan ($260* in 2009). Your meal plan will probably not cover all your dining costs. You should also include the $50 Cratis D. Williams Graduate School application fee in estimating your cost of attendance; however, this fee is not collected by the Kellogg Institute but is instead payable to the Appalachian State University Graduate School when completing that application.

Email questions to kellogg@appstate.edu or hoffmankm@appstate.edu
phone (828) 262-3057 or fax (828) 262-7183

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

You may pay your tuition and fees via Visa or MasterCard:

Visa________ MasterCard_______

Please specify: _____ Company Card _____ Personal Card

Amount Authorized: $_____________________

Credit Card Number_______________________________Expiration Date____________

Name on Card_______________________________Signature_____________________