Western Piedmont Community College
Western Piedmont Community College

2025 Burke Search and Rescue Exercise Registration Form

The following information is mandatory for all students. If this information is not provided, the student cannot be registered for requested classes.

Name(Required)
Address(Required)
Employment Status:(Required)
Highest level of education that you have completed(Required)
Please Select One
Please select from the Drop Down below one of the three options.
PUBLIC SAFETY AND TRAINING PROGRAMS(Required)
WPCC and/or the North Carolina Community College System Compliance Office reserves the right to ask for verification of fee exemption eligibility from the student and/or agency. If the information within this area is excluded, or not fully completed, the fee waiver will not be given and the cost of the class will be the responsibility of the student. If not paid, further registrations will be restricted until balance Is paid in full. Please select one.
Please Select One(Required)
Please do not abbreviate job titles. Examples To List: Firefighter, Police Officer, Paramedic
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.
Information in the space below 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 OSFM certifications. After registration is completed, this information will be destroyed.
Gender(Required)
Information in the space below 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 OSFM certifications. After registration is completed, this information will be destroyed.
Ethnic Origin: (Check One)(Required)
Information in the space below 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 OSFM certifications. After registration is completed, this information will be destroyed.
Race: (Choose One) | Required of you selected NHS Above
Information in the space below 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 OSFM certifications. After registration is completed, this information will be destroyed.

WPCC complies with the Americans with Disabilities Act and will make every effort to honor reasonable requests made by individuals with qualifying disabilities. Accommodations must be requested three business days in advance of school events or activities through the Office of Disability Services in Room 136 Hildebrand Hall or call 828-448-3154.