EDU-Network Partner  Application Form
Privacy Notice: JER does not use any information collected for any other purpose than to determine
eligibility in our program. JER will not  use the information contained herein to share with any other third party.

Main Contact Person (Administrator)
Name:
  
Departmental Unit :
  
 Title:
  
Street Address:
  
E-mail Address:
  
 
Phone Number:
  
City:
  
Fax Number:
  
State:
  
Institution's Name:
   (please post full name)
Zip Code:
  
 Unit Name:
  
Country:
  
Web Site Address:
  (leave blank if no website is in use)
Program Manager/Coordinator
(if same as above please leave blank)
Full Name:
  
Phone Number:
  
Title:
  
Institution's Fax Number:
  
E-mail Address:
  
   

 

Please click on the Submit button below. 

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Continuing and Workforce Online Education
 

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Suite 410-246
Dawsonville, Georgia 30534
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