Astoria, IL Permit No. 9
All classes must be paid for at the time of enrollment.
PAID
Non–Profit Organization U.S. Postage
Payment
Refund Policy 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.
Enroll Early!
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.
Confirmation
5800 Godfrey Road Godfrey, Illinois 62035–2466
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.
www.lc.edu/Workforce_Training
Questions? Call us! Professional Development: (618) 468–5785
SUMMER & FALL 2022
REGISTRATION FORM Please use one registration form per person. Make additional copies as needed.
Student Name___________________________________________________ Address_________________________________________________________ City______________________ State______________
ZIP_____________
Workforce Education
Solutions & Safety Training Summer & Fall 2022 Schedule of Classes
Home Phone Number______________________________________________ Alternate Phone Number____________________________________________ Email Address__________________________________________________ Gender: Male_____
Female_____
Date Of Birth___________________
Are you Hispanic or Latino? Yes_____
No_____
Are you from one or more of the following racial groups? (select all that apply) American Indian or Alaska Native_____ Black or African American_____ Native Hawaiian or other Pacific Islander_____
Asian_____ White_____ Choose not to respond_____
Identify your primary racial/ethnic group (select one): American Indian or Alaska Native_____ Black or African American_____ Native Hawaiian or other Pacific Islander_____
Asian_____ White_____ Choose not to respond_____
Certifications & Prep Page 3
Please register me in the following courses: Course Number
Name of Course
______________
________________________
Name of Course
Date
Fee
______________
________________________
_______________
________
Course Number
Date _______________
Fee ________
Total Fees ________
PAYMENT MUST ACCOMPANY REGISTRATION Check Enclosed
Credit Card
Computer Training: (618) 468–5785 Workforce Safety: (618) 468–5780
Credit Card Number______________________
Expiration Date_______
Contractor Safety: (618) 468–5780
Signature_______________________________
3–Digit Code_________
To contract a class for your company or for any other questions: (618) 468–5700
Mail form and payment to: Enrollment Center Lewis and Clark Community College 5800 Godfrey Road Godfrey, IL 62035
Supply Chain Logistics Page 4
Occupational Safety Page 6
It’s what you know.
