CONTINUING EDUCATION

WORKFORCE/CONTINUING EDUCATION REGISTRATION FORM

Note that you are not officially registered until your payment is received.

Online registration can be used for some of our shorter continuing education courses. Programs such as Phlebotomy, CNA, Medication Aide and DWI Education must be registered for in person. Please note that the class you registered for may already be full. A Vernon College representative will contact you and inform you of the next available date for that course.

Complete the course information for up to 3 courses. If you wish to register for more than 3 courses you must submit this form more than once.

Refund Policy:

Request for refund or transfer must be received at least one Vernon College business day before the first class meeting. A $5.00 charge will be applied. If a course is cancelled by the college, full refunds are mailed. Instructions and written materials are provided in English only.

COURSE INFORMATION

COURSE 1

COURSE 1 - Cource ID:

COURSE 1 - Course Title:

COURSE 1 - Room:

COURSE 1 - Start Date:

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COURSE 1 - End Date:

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COURSE 1- Days:

COURSE 1 - Time Start:

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COURSE 1 - Time End:

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COURSE 1 - Hours:

COURSE 2:

COURSE 2 - Cource ID:

COURSE 2 - Course Title:

COURSE 2 - Room:

COURSE 2 - Start Date:

Open the calendar popup.

COURSE 2 - End Date:

Open the calendar popup.

COURSE 2- Days:

COURSE 2 - Time Start:

Open the time view popup.

COURSE 2 - Time End:

Open the time view popup.

COURSE 2 - Hours:

COURSE 3

COURSE 3 - Cource ID:

COURSE 3 - Course Title:

COURSE 3 - Room:

COURSE 3 - Start Date:

Open the calendar popup.

COURSE 3 - End Date:

Open the calendar popup.

COURSE 3- Days:

COURSE 3 - Time Start:

Open the time view popup.

COURSE 3 - Time End:

Open the time view popup.

COURSE 3 - Hours:

COURSE 4:

COURSE 4 - Cource ID:

COURSE 4 - Course Title:

COURSE 4 - Room:

COURSE 4 - Start Date:

Open the calendar popup.

COURSE 4 - End Date:

Open the calendar popup.

COURSE 4- Days:

COURSE 4 - Time Start:

Open the time view popup.

COURSE 4 - Time End:

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COURSE 4 - Hours:

Contact Information:

First Name:

Middle Name:

Last Name:

Phone:

Email:

Address:

City:

State:

select

Zip:

Home Phone:

Work Phone:

SSN:

You must select a goal and answer the residency questions:
Get a Job
Improve Skills Needed in Current Job
Retrain for a New Skill
Maintain Licensure
Personal Enrichment
Other (or none of the above)

Have you been a resident of Texas for the last 12 months?
YesNo

If Yes, what country:

If No, What state did you previously apply?

Sex, birthdate, age and ethnic information must be entered: All information given is considered confidential and will be used for reporting purposes only.

Sex:
MaleFemale

DOB:

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Age:

EMPLOYEE WILL REACH OUT BY PHONE FOR PAYMENT

Type the characters you see below: