The 2023 Montessori Experience: Refresher Courses & More Certificate Request Form Professional Development Certificate Request - The 2023 Montessori Experience: Refresher Courses & 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Sessions Completion ConfirmationPlease note that a certificate of attendance will be provided for: ONE Refresher Course or Level Intensive Track (Assistants to Infancy, Primary, Elementary, or Adolescent Refresher Course, Administrators or Assistants Workshop, or Grounded and Growing). Hours cannot be provided for more than one track per person. Plus all the additional Workshops and Keynote Sessions indicated as attended on the form below. Which Sat/Sun Refresher Course or Level Intensive Track did you attend?* Assistants to Infancy Refresher Course Primary Refresher Course Elementary Refresher Course Adolescent Refresher Course Assistants to Infancy Workshop Administrator Workshop Primary Assistant Workshop Grounded and Growing 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 Monday Please select the Friday Sessions you attended: Elementary Workshop (Part 1) Cultivating Healthy Adult Relationships Science of Reading: Support for Montessori Schools Impacted by State Legislation Understanding the State of Mind that Embodies Montessori's Spiritual Preparation Research Presentation (Part 1) Elementary Workshop (Part 2) Allowed & Proud: LGBTQ+ Inclusion in our Schools Walking in Her Shoes: Presenting...Dr Montessori and the Trailblazers of The American Montessori Movement Integrating the Arts to Awaken Mindfulness, Spiritual Alignment, Civic Engagement and Social Justice Advancing Research in Montessori: Round Table The Future of Montessori Advocacy Please select the Friday Keynote Session you attended: Grace, Grit and Glory: The Wings of Education and Happiness Please select the Monday Sessions you attended: Research Presentation (Part 2) Becoming Awestruck: Igniting the Science of Transcendence in Montessori Communities How To Do What We Need to Do, With Montessori Intact Exploring the Montessori-Wellness Connection Using Montessori Materials to Invite Meaningful Engagement and Maintain Skills for Adults Living with Dementia Please select the Monday Keynote Session you attended: Sisters in Spirit Total # Non-Level Intensive Session Hours:Total # Keynote Hours:Total # of Hours:Consent* I verify that I have attended 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 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Email address to send credit card receipt* CAPTCHANameThis field is for validation purposes and should be left unchanged. 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