- Western Piedmont Community College

This field is for validation purposes and should be left unchanged.

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

Required Information

Information in this area is for record keeping purposes only and will not be used in a discriminatory manner. However, this information is required for federal reports, state reports and state certification. After registering for your class, this information will be destroyed.

Name*

First Last

Middle Initial:

Email Address:*

Gender*

Female
Male

Ethnic Origin:*

(Check one)- If you select the NHS option, please complete the following RACE section:

Hispanic (HIS)
Non-Hispanic/Latino (NHS)

Race:*

Choose one

Alaskan Native/American (AN)
Asian (AS)
Black or African American (BL)
Hawaiian/Pacific Islander (HP)
White (WH)

WPCC Student ID

(If known)

Mailing Address:*

Street Address City State ZIP Code

County of Residence:*

Primary Contact Phone:*

Work Phone:

Date of Birth:*

Age Check*

Persons age 16 or 17 years and enrolled in high school may concurrently enroll in selected Workforce and Continuing Education courses.

Are you still enrolled in high school?

Yes
No

Acknowledgement

If you are still enrolled in high school, you must certify by placing your initials in the box that you are in good academic standing and are making satisfactory academic progress toward graduation prior to being registered for this class.

Employment / Education

The following information is mandatory for ALL STUDENTS. If this information is not provided, the student can not be registered for requested class(es).

Employment Status*

Highest level of education 1-12 that you have completed:*

Month/Year last attended High School:*

Highest Level of Education Completed:*

Certification of Accuracy

By submitting this online registration form, I certify to the best of my knowledge that the information given is true and complete and agree that my electronic signature is the legal equivalent of my manual signature. Further, I understand that by submitting this information via electronic transmission that I acknowledge the following: 1) I do not have any outstanding balances with WPCC 2) I understand that I cannot register into a class that meets at the same time of another WPCC class for which I am registered and 3) I understand that if I falsify any information on any of the information above, I may be removed from the class. Permission is granted to release appropriate course information to certifying agencies

Electronic Signature:*

First name, middle initial, last name

Class Information

CANCELLATION POLICY/REFUND POLICY: If WPCC cancels a class, the student will be notified. A one-hundred percent registration fee refund for Workforce and Professional Development classes shall be made upon request of the student if the student officially withdraws from classes at least one business day prior to the class start date. A seventy-five percent registration fee refund for Workforce and Professional Development classes shall be made upon request of the student if the student officially withdraws from classes prior to or at the 10 percent point of the class. Requests for refunds will not be considered after the 10 percent point. The refund policy does not apply to self-supporting classes. To officially withdraw from a class the student must request to be withdrawn from the class in person (special accommodations can be made for students who live outside of a 50 mile radius). A "Request for Refund" form can be obtained from the appropriate registration personnel located in the office of Records and Registration.

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

First Class

Class Title*

Class Section Number*

Class Beginning Date*

Class Cost*

Add additional courses:

Add another course

Second Course

Class Title

Class Section Number

Class Beginning Date

Class Cost

Add additional courses:

Add another course

Third Course

Class Title

Class Section Number

Class Beginning Date

Public Safety and Training Programs: Fee Waived Classes Only

WPCC reserves the right to ask for verification of fee exemption eligibility from the student and/or agency.

For fire, rescue, law enforcement, ect. Information below is required. Either/Or - Select One*

Volunteer
Or Paid

For fire, rescue, law enforcement, ect. Information below is required. Either/Or - Select One*

State
Or Local / County Agency

Please note that to be eligible for fee exemption, the course/s you are registering for must be directly related to job performance or necessary to continue certification. If this information is not populated in its entirety, there will not be a fee waiver and the student will be responsible for payment.

Department Affiliation (i.e.: Fire, Rescue and Basic Law Enforcement)

Department/Agency Name No Abbreviations:

Job Title:

Information in this area is for record keeping purposes only and will not be used in a discriminatory manner. Hoever, this information is required for federal reports, state reports and state certification. After registration into your class, this infomratino will be destroyed.

Last four of SSN:*

Workforce/Professional Development Online Registration Form - Fire/EMS

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

Required Information

Employment / Education

Certification of Accuracy

Class Information

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

First Class

Second Course

Third Course

Public Safety and Training Programs: Fee Waived Classes Only

Information in this area is for record keeping purposes only and will not be used in a discriminatory manner. Hoever, this information is required for federal reports, state reports and state certification. After registration into your class, this infomratino will be destroyed.

Student Resources

General Information

Faculty & Staff

Campus Information

WPCC

STUDENT PANEL

WHY WPCC

GET STARTED

PAY FOR COLLEGE

SERVICES & SUPPORT

COMMUNITY

STUDENT PANEL

Workforce/Professional Development Online Registration Form - Fire/EMS

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

Required Information

Employment / Education

Certification of Accuracy

Class Information

Students must register and pay any registration fees two business days/48 business hours prior to the start date of the class.

First Class

Second Course

Third Course

Public Safety and Training Programs: Fee Waived Classes Only

Information in this area is for record keeping purposes only and will not be used in a discriminatory manner. Hoever, this information is required for federal reports, state reports and state certification. After registration into your class, this infomratino will be destroyed.