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MSTC Registration Form - jg


Timertimer
* = required field
      Adams Center
401 North Main Street         
Adams WI 53910
Phone: 608.339.3379
Fax: 608.339.9625
Marshfield Campus
2600 West Fifth Street         
Marshfield WI 54449
Phone: 715.387.2538
Fax: 715.389.2864
Stevens Point Campus
933 Michigan Avenue
Stevens Point WI 54481         
Phone: 715.344.3063
Fax: 715.342.3134
Wisconsin Rapids Campus
500 32nd Street North
Wisconsin Rapids WI 54494
Phone: 715.422.5300
Fax: 715.422.5561

Toll-free: 888.575.MSTC TTY: 866.331.3603 Web: mstc.edu

Step 1 - Demographic Information
Last Name: * First Name: * MI: *
Former Names:    Gender: *
MSTC Student ID #:    Social Security Number:    Date of Birth (mm/dd/yyyy): *
U.S. Citizen? * Veteran?   

Driver's License # (Required for Motorcycle Rider Course Registration only):   
Are you Hispanic or Latino (that is Cuban, Mexican or Puerto Rican, South or Central American regardless of race)?   
Check one or more from the following that bests describes your race:   

If you chose "Other" please describe:

  

Are you a high school graduate? * High School Grad Date:   
High School Attended:    City/State:   
If you did not graduate, did you complete a GED/HSED?:    Date of HSED/GED Completion:   

Step 2 - Address/Phones
Street Address: *
City:            * * Zip Code: *
County:    Legal Resident of:      
Home Phone:    Work Phone:    Mobile Phone:   
   Please check here if your address has changed since the last time you attended MSTC.

Step 3 - Registration for Classes
Please enter the five-digit class number below for each class you are enrolling in.

Submitting this form does not guarantee a seat in the class. Availability is determined when registration and payment (if required), are entered by college staff.

Class Number Class Title Campus
*      
        
        
        
        
        


Step 4 - State Data Survey:
Please answer the following questions. This information is requested for state and federal reporting purposes only. When reported, this information is not personally identifiable. MSTC maintains this information in compliance with FERPA and federal privacy requirements. Accurate data enables MSTC to obtain state and federal funding that supports education and service to our students. Your response is appreciated.

*
*
  
*
*
*
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Step 5 - Payment of Tuition and Fees
Choose one of the following options:
  
  
  
            Funding Agency Name:   
            Funding Agency Phone:   
            Funding Agency Billing Address:   
                                                                        
*Any charges not covered by the third party vendor are the sole responsibility of the student.
 Authorization must be on file in order to process registration and third party billing to occur.


Step 6 - Agreement / Submit Registration
I agree, according to MSTC's payment policy, to be responsible for the payment of related tuition and fees for the class(es) I am enrolling in above. Should I choose not to attend, I need to drop the class(es) prior to the day the class(es) begins to avoid any charges. I understand that drops that occur on or after the first day of a class will result in tuition charges to my account. By submitting this form, I agree to the terms and conditions stated above.
Submitting this registration form does not guarantee placement into selected classes.   Registrations are processed on a first come first served basis.  Enrollment is based on class availability and payment (if required) of tuition and fees.
Mid-State Technical College collects your Social Security Number for record keeping and statistical purposes related to auditing, enforcing, and evaluating federally supported education programs (Federal Law 20 U.S.C.s. 1232g (1998)) only. You are required to provide your Social Security Number if you are, or will be applying for financial aid.


Equal Opportunity Educator and Employer