For Instructors

LearningBranch Course Order Form

Your Name (required)

Your Email (required)

Institution

Program

Course Details

Start Date YYYY-MM-DD

End Date YYYY-MM-DD

Expected Number of Students

LearningBranch Course

Do you need a course with a different assembly of units than shown on the outline?

YesNo

If Yes, please provide more details and we will contact you.

Billing Info

Will the students be purchasing the course individually from LearningBranch?
YesNo

If No, please provide the contact for bulk invoicing, if different than yours.

Name for Billing

Email for Billing

Additional Information