The 2022 Montessori Experience: Refresher Course & More Certificate Request Form Professional Development Certificate Request - The 2022 Montessori Experience: Refresher Course & More Please use this form to request a course completion certificate. Thank you for attending this year's conference! For the full agenda, list of presenters and hours allotted, please see here. Attendee InformationName* First Name Middle Name (optional) Last Name How would you like to receive your certificate?* Digitally (email address required) Printed on cardstock (mailing address required), incurs a $5 fee Certificate requests will be fulfilled as quickly possible. Your patience is appreciated!Your Email Address* Your Address* Address Line 1 Address Line 2 City State ZIP Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Session(s) Completion ConfirmationPlease note that a certificate of attendance will be provided for: ONE Refresher Course or Level Intensive track (A to I, Primary, Elementary Refresher Course, Implementing Strong Montessori Elementary Level Intensive (Open Track), Adolescent, Administrators, Assistants, Play, Sing & Dance). You're more than welcome to view the other sessions at your leisure but hours cannot be provided for more than one track per person. Plus all the additional Workshops and Keynote sessions indicated as attended on this form below Which Sat/Sun refresher course or level intensive track did you attend live or will be viewing?* Assistants to Infancy Primary Elementary Refresher Course (AMI elementary diploma required): Movement and Observation: A Path to Self-Knowledge Implementing Strong Montessori Elementary (Open Track) Adolescent Administrators Assistants Play, Sing & Dance: Music and Movement in the Montessori Classroom None Refresher course or level intensive track hours:Please enter a number from 1 to 12.Do you also require hours for: Non-Level Intensive Sessions Keynotes For which session days? Friday Saturday Monday Please select the Friday session(s): Opening Session Priming the Pump Making an Impact Globally Jazz and Social Justice (virtual) Resilience Through Creativity See Myself and Be Myself: LGBTQ+ Inclusion in the Casa and Infant Community Climate Justice as the Critical Educational paradigm for Montessrians Beloved Reclamation: Using Culturally-Centered Narratives to Support Healing and Well-Being (Virtual) Policy and Advocacy for the Future of Montessori English Learner Support in Montessori Training Please select the Friday session(s) Keynotes: Strengthening Resilience through Creative Expression Please select the Saturday session(s): Movement as a Foundation of Wellness in Montessori Please select the Monday session(s): Growth Mindset: A Path Towards Creativity and Resilience The Power of Emotions in Teaching: Increasing Resilience and Creativity Educateurs sans Frontières – A Conversation About Local Challenges and Creative Solutions La Preparación Espiritual del Adulto en Tiempo de Incertidumbre Closing Session Please select the Monday keynote session(s): Leveraging Creativity and Resilience in Schools Closing Keynote: Inclusive Education for a Neurodiverse World: Radically Reevaluating Your Relationships Total # Non-Level Intensive Session Hours:Total # Keynote Hours:Total # of Hours:Consent* I verify that I viewed or will be viewing all sessions for which I'm requesting a certificate.*Payment InformationMailed Certificate Price: Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Email address to send credit card receipt* CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. 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