38.14 Registration Form - Workforce Solutions

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Workforce Solutions Registration Form

Step 1 - Demographic & Address Information

Today's Date:

Last Name

First Name:

Middle Initial

Former Name/s (if applicable):

Student ID # (if known):

Job Title:

Department Name:

Mailing Address:

City:

State:

Zip Code:

County:

Legal Resident of:

Primary Phone:

Phone Type:

Secondary Phone:

Phone Type:

Gender at Birth:

Date of Birth:

Social Security Number:

U.S. Citizen?

Are you Hispanic or Latino? (Cuban, Mexican or Puerto Rican, South or Central American regardless of race)

Choose one or more from the following that bests describes your race:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian/Pacific Islander

White

Personal email Address:

Are you a high school graduate?

If you did not graduate, did you complete a GED/HSED?:

Date of HSED/GED Completion:

Step 2 - 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. Moraine Park Technical College maintains this information in compliance with FERPA and federal privacy requirements. Accurate data enables Moraine Park to obtain state and federal funding that supports education and service to our students. Your response is appreciated.

1. Highest Grade Completed:

2. Highest Credential Received:

3. Highest degree earned by either parent:

4. Veteran Status:

5. Work Status at Enrollment:

6. Which of the following best describes your status as a parent:

7. Disability:

8. Foster Care Youth:

(Are you between the ages of 16-24 and are or were part of the foster care system?)

9. Do you meet the criteria for being homeless?:

(In the past year have you been homeless? This could include living in your car, sleeping on a friend's couch, staying in a shelter or living in temporary housing - like a motel).

10. Parent in Armed Forces:

(Are you between the ages of 16-24 with a parent on active duty in the armed forces?)

8. Economically Disadvantaged:

(Includes any individual or member of a family who is unable to pay for one or more basic living needs, who receives need-based financial assistance, or whose income is at or below the poverty level as defined by the U.S. Department of Health and Human Services.)

Step 3 - Registration for Classes

Select the class you are registering for below.
(Use the search box to type the class name or scroll to search)

Step 4 - Company Information

Company Name

Supervisor

Supervisor Title

Supervisor Email

Billing Address

City

State

Zip Code

County Located

Step 5 - Agreement / Submit Registration

Moraine Park 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 for IRS 1098T tax reporting.

By submitting this form, I certify that the above information is correct. I authorize Moraine Park Technical College to release a copy of this form and any academic records related to this training to my employer or personnel/training officer sponsoring the training.

Cancellations received five (5) full business days before the start date of the training are eligible for a full refund. Companies or individuals canceling with less notice, or failure to attend without notice, are responsible for the full fee.

Moraine Park Technical College (MPTC) may cancel training because of insufficient enrollments or other circumstances requiring it. If MPTC cancels the training, participants will receive a full refund.

Full Name:

Standard 38.14 Multiple Recipient Service Agreement Provisions: It is understood that Moraine Park Technical College retains the proprietary rights to any College curriculum materials used or developed as part of this contract. Moraine Park Technical College employees performing under this contract remain under the exclusive control of the College. Permission required prior to any media production. The Service Recipient certifies, as party to this contract, that it does not discriminate against employees, enrollees or applicants for employment or enrollment on the basis of age, race, color, sex, creed, handicap, political persuasion, ancestry or sexual orientation, except where there is a bona fide occupational qualification. The District board has authorized selected Moraine Park Technical College District representatives to initiate contracts. This agreement is subject to retroactive approval by the Board of Moraine Park Technical College District. Both parties to this contract agree that fiscal and/or programmatic modifications may be made as mutually agreed to by the parties involved.

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