www.lc.edu/CCL
Astoria, IL Permit No. 9
Non–Profit Organization U.S. Postage
PAID
5800 Godfrey Road Godfrey, Illinois 62035–2466
Female_____ No_____
Date Of Birth___________________
Asian_____ White_____ Choose not to respond_____ Asian_____ White_____ Choose not to respond_____
Date Date
Check Enclosed
Safety Training: (618) 468–5780
Mail form and payment to: Enrollment Center Lewis and Clark Community College 5800 Godfrey Road Godfrey, IL 62035
3–Digit Code_________
Expiration Date_______
Credit Card
PAYMENT MUST ACCOMPANY REGISTRATION
________
Total Fees
Signature_______________________________
Corporate Training: (618) 468–5700
Fee
______________ ________________________ _______________ ________
Course Number Name of Course
College for Kids: (618) 468–5750
Swim: (618) 468–5760
Fee
______________ ________________________ _______________ ________
Course Number Name of Course
Please register me in the following courses:
American Indian or Alaska Native_____ Black or African American_____ Native Hawaiian or other Pacific Islander_____
Identify your primary racial/ethnic group (select one):
American Indian or Alaska Native_____ Black or African American_____ Native Hawaiian or other Pacific Islander_____
Are you from one or more of the following racial groups? (select all that apply)
Are you Hispanic or Latino? Yes_____
Gender: Male_____
Email Address__________________________________________________
Alternate Phone Number____________________________________________
Credit Card Number______________________
Personal Enrichment: (618) 468–5785
ZIP_____________
Home Phone Number______________________________________________
City______________________ State______________
Address_________________________________________________________
Student Name___________________________________________________
Please use one registration form per person. Make additional copies as needed.
SPRING 2017 REGISTRATION FORM
Technology: (618) 468–5785
Professional Development: (618) 468–5750
General: (618) 468–5701
Questions? Call us!
Once your fee is paid you are officially registered. Plan to attend the first session as scheduled. You will be notified if the class is canceled.
Confirmation
All classes have limited enrollments and are filled on a first–come, first– served basis. Each class also has a minimum required enrollment. If this minimum is not met prior to a class starting, the class will be canceled and enrollment fees returned.
Enroll Early!
For classes that meet four or more times, you may withdraw before the start of the second session in order to receive a refund. There are no refunds for classes that meet three or fewer times once the class has begun. To withdraw, call the Enrollment Center at (618) 468–7000.
Refund Policy
All classes must be paid for at the time of enrollment.
Payment
College for Kids Page 6
It’s what you know.
Personal Enrichment Page 3
Workforce Training Page 10
Spring 2017 Schedule of Classes
learning
Corporate & Community