Summer 2026 TExpL Guest Registration Form

Summer 2026 TExpL Guest Registration Form
This form is for Guest Registration Only for summer graduate coursework through Total Experience Learning.
If you are a current Alvernia student, please do not complete this form.
Alvernia students should register via self service (click here) or contact your advisor for assistance.
Are you currently enrolled at Alvernia University?
Alvernia Student ID# (if you are a former student)
Name

First NameLast Name
Former Last Name (if applicable)
Date of birth

MonthDayYear
Date
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Email Address
example@example.com
Confirm email address
example@example.com
Preferred Phone
Please enter a valid phone number.Format: (000) 000-0000.
Are you an educator participating in Act 45/48?*
Enter PPID#
School District/Employer Name
Is your district assisting with tuition reimbursement for this course?
I have paid the $300 program fee for MED690.
Please register me for MED690: Creativity and Innovation at Oxford University.
Signature - To the best of my knowledge, the information provided is accurate. I agree that, if accepted, I will comply with the rules and regulations of Alvernia University.
Date

MonthDayYear
Date
By hitting submit, you are agreeing to all of Alvernia University's policies, procedures, tuition and fees. You will be registered for this course unless otherwise noted by the University. If any changes to the registration are needed, they must be completed in writing to caryn.stopper@alvernia.edu by the appropriate deadlines set forth in the academic calendar.
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