Clinical Research Certificate Program: Summer 2017

Please note: Completion of this form does not guarantee course enrollment. Enrollment will be confirmed via email once the registration request period ends. The deadline to submit registration requests for Summer term courses is Monday, June 5th. You will be notified via email after Monday, June 12th.

If you have any questions, please email: ccebcert@mail.med.upenn.edu

Name - Last
Name - First
Email
Summer 2017 Courses

Note: You must complete a separate form for each course.
Select Registration Option

Select Registration Option Non-Credit Credit

Note: Please see below eligibility requirements.
Non-Credit vs Credit Registration Eligbility
NON-CREDIT - This option is only available to University of Pennsylvania affiliated medical students, residents, fellows and post-doctoral fellows. Participants will not have official registration/active student status in the University's Student Record System. The fee for each course is $200. CREDIT - This option is available to anyone interested in taking our non-degree courses. Participants will be formally registered in the University's Student Record System and charged full tuition. Eligible faculty and staff may receive tuition assistance through the University's tuition benefits. Please contact our office for current tuition rates: ccebcert@mail.med.upenn.edu
Department/Division
Affiliation
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Position
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PennKey (no passwords)

PennKey is required to access the Canvas Course Management site. If you do not have a Canvas account there is an additional form to complete.
Date of Birth Date of Birth / MM / DD YYYY
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Thank you! Please note: Completion of this form does not guarantee course enrollment. Enrollment will be confirmed via email once the registration request period ends.