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Questionnaire and Application

For

The International Cyber Education Review Board - ICERB

Selected participants will be involved in the review and evaluation of the world’s first complete Internet Cyber-Educational Web- Site. Participants names will be listed on ICERB’s   International Registry of Evaluators and given special pricing and access to all aspects of the curriculum as well as access to courses and materials in development.

Name*     *REQUIRED
Address   City
State   ZIP Code
Phone Number*   Email Address*

The I-CERB team will include home educators, parents and  professional educators.  Please indicate with a check mark one or more of the following titles.

Professor  
Elementary Teacher  
High School Teacher   
Administrator  
Home Educator  
Parent Please list the number and ages of your children if applicable
  No. Of Children    Ages Of Children
Student Age  Grade Level
   
Please list any subject(s) of specific interest
Educational Experience (if applicable)
Why would you like to be included in ICERB?
   
Please circle the number that describes your familiarity with the Internet