Registration Form – Alliance for Lifelong Learning (ALL) Continuing Education, Training, and Workforce Development
Four ways to register: 1. Online - oakton.edu/conted 2. Mail - Alliance for Lifelong Learning, P.O. Box 367, Skokie, IL 60077 3. In Person - Room A120 at the Skokie campus or Room 1170 at the Des Plaines campus 4. Fax - 847.635.1448
PART A: Personal Information (All fields are required)
Student ID Number or SSN
Last Name
First Name
Middle Initial
Street Address
City
State
Zip
□ Cell or □ Business Phone
Preferred Email
Date of Birth
Gender □ Male □ Female
Home Phone
Last high school attended (Name, city, state) PART B: Educational Information
Are you a first generation college student? □ Yes □ No Most credits or highest degree previously earned: □ Some credits □ Certificate
Check one box that best describes your high school status: □ High school graduate or expected date of graduation: _____________ □ Passed G.E.D test in ___________ (year) □ No longer attending high school and do not intend to return
□ Associate degree
□ Bachelor’s degree □ Doctoral degree □ CEHP Profession/License No. ______________________________________ □ Master’s degree
1. Are you Hispanic or Latino? (OR Are you of Spanish origin?) □ Yes Hispanic or Latino. □ Not Hispanic or Latino. 2. Are you from one or more of the following racial groups? (Select all that apply). □ American Indian or Alaska Native □ Asian □ Black or African American □ Native Hawaiian or Other Pacific Islander □ White □ Choose Not to Respond 3. Please identify your primary racial/ethnic group. (Select one). □ American Indian or Alaska Native □ Asian PART C: Demographic Information (This information is requested solely to comply with Federal laws)
□ Black or African American
□ Hispanic or Latino
□ Native Hawaiian or Other Pacific Islander
□ White
□ Choose Not to Respond
4. Are you in the United States on a Visa – Nonresident Alien? □ Yes in the United States on a Visa. □ Not in the United States on a Visa. Provide Home Country of Origin: ___________________________________________
PART D: Course Information
□ Fall
□ Spring
□ Summer Year: __________________
To register for more classes than space allows, please submit another registration form with Part D completed. CRN Course Code Course Title Location Start Date Day/Time
Tuition
+$4 * +$4 * +$4 * +$4 *
Subtotal Administrative fee Total due
Full Payment is due at the time of registration. Check the Tuition and Fees page in this schedule for refund policy. Method of payment: □ Cash □ Check No. _________________ (payable to Oakton College) □ Visa □ MasterCard □ Discover
$12.00 **
Credit Card Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Registration Received: _________ ____________ _________ Registration Processed: _________ ____________ _________ Payment Processed: _________ ____________ _________ OFFICE USE ONLY Site Date Initials Student Status: □ New □ Readmit □ Hold Update: □ Name □ Address □ Phone □ Email Senior Status: □ Prior to 7/7/14 □ After 7/7/14
Exp. Date ___ ___ /___ ___ ___ __ Three-Digit Verification Code (on back of card) ___ ___ ___
Cardholder Name (print) ______________________________________________________________________
Cardholder Signature ___________________________________________________________ ______________
Confirmation will be sent to the email on file. * Effective with the Fall 2022 semester, a $4 technology fee will be added per class. Students who register online will not be charged any additional fees. ** Those registering in person, by mail, or by fax will be charged an additional $12 administrative fee with each registration form. Fees are non-refundable.
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