Extended Learning Registration Form

Extended Learning
Registration Form

Complete the form below including class number(s) and title(s).

Do Not include a credit card number now!
For your security, you will receive a confirmation e-mail from Enrollment Services within 2 business days with payment instructions.

This Registration Form is for 9000-series item number only. Please visit Enrollment Services to learn how to enroll in other classes.

Last Name

Middle Initial

First Name

Address (Number & Street, Route & Box or PO)

Apt #

Previous Last Name(s) used at LWTC

City

State

Zip

Email Address

I understand I need to contact the Registration office to provide my social security number.

I will not provide my social security number. I understand that by not providing this information, some college services (such as financial aid and official transcripts) will be unavailable or limited.

Day Phone

Evening Phone

Male
Female

Birth
Month

Birth
Day

Birth
Year

Please enroll me for the following classes:

Add	Item Number (e.g. 9565)	Course Number (e.g. COFU 122)	Course Title:




Comments:
You will be contacted by someone from Enrollment Services with further details, including payment information.

To complete your enrollment request, please provide us with the following information. Lake Washington Technical College provides equal opportunity in education and does not discriminate on the basis of age, color, national origin, sex or disability. This information is utilized only for demographic purposes and state reporting.

Have you attended LWTC before?

Yes

Please select the quarter you are planning to attend

How will your course work relate to your current or future work?

Gain skills for a new job or career
Gain skills for my current job or career
Improve skills for a career change
Does not apply
Other

What is your main long-term purpose for attending this college?

Take courses related to current or future work
Transfer to a 4 year college and earn a degree
High School Diploma or GED
Explore career direction14
Other

Are you a US citizen? Yes No - If no complete the following:

Permanent Resident? Yes No - If yes, alien number
Refugee? Yes No - If yes, I-94 number
If none of the above, Visa type (example, H-4)

Other status in the US - please explain

How long do you plan to attend this college?

What is your current work status while attending?

What is your level of education at entry to LWTC?

What was your family status when you started at LWTC?

What race do you consider yourself to be