Workforce Development Home Page
Fall Semester Registration/Admission Form

IMPORTANT: You will not be officially registered for class until we receive your Employer/Agency Billing Form or payment.  
Last Name First Name MI

Mailing Address:
 
     City: State: Zip:
County:

E-mail Address:  

Phone (Home):     Phone (Work):

Academic Period
Fall
Spring
Summer
     Year       Have you been an Ohio resident
for the past 12 months?
   Yes   No
Social Security Number:   

Agency Billing? Yes  No    If yes, Agency Name:

CHOOSE FROM THE COURSES BELOW:    ( also see courses for   Spring   Summer )

For credit courses only, a $30.00 registration fee is charged once per semester, per student. In addition to the course cost, a $3 technology fee is charged per credit hour per course. Most courses will require a textbook.


 Call #Course #TitleDay/Date/TimeInstructorRoomCreditPrice

( also see courses for   Spring   Summer )

1.  Gender:    Male     Female
2.  Marital Status:
     Married    Single    Separated  Divorced   Widowed
3.  U.S. Citizen:    Yes     No
     If No, what country?   

The following information is requested to comply with U.S. Department of Education reporting requirements and for college research purposes. This information is not used in either college or program admissions decisions.
4.  Date of Birth:  
5.  Ethnicity/National Origin:
       Black, non-Hispanic    Asian or Pacific Islander    White, non-Hispanic
       American Indian/Alaskan Native   Hispanic     Non-resident, alien


--- if you are registering for a non-credit course or a course that earns CEU's stop here ---
6.  Term and year you plan to enroll:
       Fall    Spring     Summer   Year
7.  Entry Status (choose one):   
8.  Academic Intention (select one):
       
9.  High School:
        Graduated from High School   Received a GED
        Have not received a high school diploma or GED
       School Name:     Graduation date:   
       City:     State: 


 
By sending this, I agree the information on this registration/admission form is true and correct to the best of my knowledge.