Enrollment: The Continuing Education Program

The Enrollment form below allows you to enroll a student in The Continuing Education Program. Please complete one form for each student you wish to enroll. Once you complete this form, student enrollment is automatic. This is the only enrollment form you will need to complete! (Please do not use all caps and instead use upper and lower case letters.)
The fields marked with * are necessary.

Company Information
*Company:
*Address (Line 1):
Address (Line 2):
*City:
*State: (If none type: NA)
*Zip Code:
*Country:
*Phone:
*Managers First Name:
*Managers Last Name:
*Manager E-Mail:
*Name of Person Requesting Enrollment:
   
Student Information
*Student First Name:
*Student Last Name:
*Student Email:
*Student User Name:
*Student Password:
*Confirm Student Password:
   
Additional Information
*Sponsor:
*Dealer Number (Required):
*One Enrollment Form
for each student in The Continuing Education Program:
A tuition of $249 (per store) will occur on a monthly basis for The Continuing Education Program. (This program requires that each student be enrolled separately.) You may enroll up to 50 students per location for this monthly tuition amount.

*Please Note: If all students in The Continuing Education Program graduate from any one month's learning module, this creates an "In Bonus" status. This may qualify you for special tuition credits from The Glenn Roller Institute and/or special incentives from a sponsoring manufacturer.
Comments:
 
 
 

Student Withdrawal

Click to withdraw a student from The Continuing Education Program:
Withdrawal