This registration is for entities already approved to provide Professional Development in Illinois. If you are interested in becoming an approved provider, please review the IL State Professional Provider Requirements and Application .

Provider Information

Name

Please be sure the Name exactly matches the one assigned to the RCDT code.

Provider Name is required.

RCDTS

RCDTS Code is required.

Address Line 1

Provider Address is required.

Address Line 2 (Optional)

City

City is required.

State

Please provide a valid state.

Zip (5 digit)

A 5 digit Zip code is required.

Were you approved through the application process or are you statutorily approved?

If statutorily, please choose which best describes you.

Contact Person 1

Name

Provider name is required.

Last name

Valid last name is required.

Title

Please enter a valid email address.

Phone

Phone Number is required and must be in the format ###.###.####.

Contact Person 2 (Optional)

Name

Last name

Title

Phone

Phone Number must be in the format ###.###.####.

Activity Information

Do you charge for any of your PD activities? (Yes or No)

On average, how many professional development activities do you provide each year? (excluding AAs)

Check box if you offer online/on demand PD opportunities.

Current Professional Development/Learning Management System

Check box if you currently have a professional development system or learning management system that allows users to search and register for professional development opportunities.

Check box if you are under contract for use of your current system.

Professional Development Provider Registration Form

Provider Information

Contact Person 1

Contact Person 2 (Optional)

Activity Information

Current Professional Development/Learning Management System

Thank you for registering!

Unsuccessful