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Career Choices Users Only Registration Request

Please take a few moments to fill out the following form to request your Users Only Membership and receive your annual password. The information will be sent to you at the School/Agency e-mail address specified below.

Name: *
School / Agency: *
Department:
Title:
Discipline:
Street Address: *
City: *
State: *   Zip: *
Phone: *   Ext:
Fax:
E-mail Address: *
District:
District City:
District State:   District Zip:
Agency Type:

Please tell us about your program:
Materials in use: Career Choices
Workbook and Portfolio
Possibilities
Lifestyle Math
Lifestyle Math Companion Software
Lifestyle Math online correction key
Instructor's and Counselor's Guide
Grades using Career Choices:
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
other grade(s)
Number of students using Career Choices:
Our Career Choices course lasts:
Our books are funded by:
Please list any of your peers using Career Choices:

Please sign me up for the following free services:
Focus on the Future, our newsletter for Career Choices users:
Career Choices Forum, our online discussion group for Career Choices users:
Free curriculum support including funding information and lesson plans:

If you would prefer to receive our mailings at an alternate address, please enter it here:
Alternate Address:
Alternate City:
Alternate State: *   Alternate Zip: *
Alternate E-mail Address: *

Please indicate which training opportunities you are interested in:
2-day Focus on the Future workshop in Santa Barbara, CA:
1-day Integrating Academics, Technology and Career Guidance Workshop held in my area:
Career Choices Workshop Video (available on a 3 week free loan):
Bringing a Career Choices Certified Trainer to my school for an in-service training:
* Indicates required fields.
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Career Choices received a promising Intervention Award from the U.S. Department of Education for its effectiveness in
reducing dropout rates and supporting higher achievement in reading and math.
”   -ACTE’s Techniques magazine