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Continuing Education Registration

Please complete the form below. Required fields marked *

On-Line registration must be completed three (3) days prior to the scheduled start date of the class.

Course Title*

Begin Date*

End Date

(if known)

Last Name*

First Name*

Middle Name

Address

Street Address*

City*

State*

Zip/Postal*

County of Residence*

State of Residence*

You must enter an EMAIL, HOME PHONE, or CELL PHONE. (All are preferred)

Home Phone

Cell Phone

Social Security Number

Ex.999999999

Date of Birth*

High School Last Attended*

Month and Year last attended high school*

Email Address

EMERGENCY SERVICE PERSONNEL ONLY

If you are Emergency Services Personnel and are attending an Emergency Services Class which is fee waived, provide your agency name. Failure to do so will result in the student being charged for the class.

MOTORCYCLE SAFETY COURSE ONLY

If you are under 18 years of age, DO NOT register on-line. You must register at McDowell Technical Community College with a parent present

If yes, state of driver's license issuance

Driver's License Number

Expiration date shown on driver's license

Upload a copy of your Driver's License

You can simply use your smart phone to take a photo and upload the picture of your driver's license

Choose a file or drag it here.

DEFENSIVE DRIVING COURSES ONLY

Please Note: All Defensive Driving Courses are self-supporting classes and the registration fee is non-refundable. Refunds are made only if the class does not make. Students that do not show up for the class on the date they are registered will need to complete the registration process again (including registration fee) for the next available class.

By completing the remainder of the form and signing at the end, I acknowledge that I understand all the information above.

If yes, state of driver's license issuance

Driver's License Number

Expiration date shown on driver's license

Upload a copy of your Driver's License

You can simply use your smart phone to take a photo and upload the picture of your driver's license

Choose a file or drag it here.

Upload a copy of your citation

You can simply use your smart phone to take a photo and upload the picture of your citation

Choose a file or drag it here.

Upload a copy of the District Attorney permission form if applicable

If you had to have permission from the DA to take this course, you can use your smart phone to take a photo and upload the picture of the permission form

Choose a file or drag it here.

Certification of Accuracy

By submitting this online registration form, I certify to the best of my knowledge that the information given is true and complete. Further, I understand and agree that my electronic signature is the legal equivalent of my manual signature.

I certify to the best of my knowledge that the information given is true and complete. Further, I understand that by submitting this information via electronic transmission that I acknowledge the following: I do not have any outstanding balances with McDowell Technical Community College. I understand that I cannot register into a class that meets at the same time of another MTCC class for which I am registered. I understand that if I falsify any information on the demographics information above, or on any future registration forms, my certification will be eliminated. I understand and agree that my electronic signature is the legal equivalent of my manual signature. Permission is granted to release appropriate course information to certifying agencies.

Electronic Signature *

(First Name, Middle Initial, Last Name)

Acknowledgement*

I acknowledge that the above typed name is my signature.

Once you submit this form, someone from the Continuing Education and Workforce Development Department will contact you for further instructions.

Thank you for Registering for classes at McDowell Technical Community College. We are delighted to serve you.

Confirmation Email

Confirmation Email *

Enter your email address here if you'd like to receive a confirmation upon submitting the form.