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)
First Name
Last Name
Middle Initial
Student ID Number or SSN
City
State
Zip
Street Address
□ Cell or □ Business Phone
Preferred Email
Gender □ Male □ Female
Date of Birth
Home Phone
PART B: Educational Information Last high school attended (Name, city, state)
Are you a first generation college student? □ Yes □ No
Most credits or highest degree previously earned: □ Some credits □ Bachelor’s degree □ CEHP Profession/License No. ______________________________________ □ Certificate □ Master’s degree □ Associate degree □ Doctoral degree
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
PART C: Demographic Information (This information is requested solely to comply with Federal laws)
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 □ Middle Eastern or North African □ Native Hawaiian or Other Pacific Islander □ White □ Choose Not to Respond 3. 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 To register for more classes than space allows, please submit another registration form with Part D completed. □ Spring □ Summer □ Fall
Year: __________________
CRN
Course Code
Course Title
Location
Start Date
Day/Time
Tuition
+$4 * +$4 * +$4 * +$4 *
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
Subtotal Administrative fee Total due
$12.00 **
Credit Card Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
OFFICE USE ONLY Registration Received: Registration Processed: Payment Processed: Student Status: Update: Senior Status:
Site
Date
Initials
____________ ____________ ____________
_________ _________ _________
Exp. Date ___ ___ /___ ___ ___ ___ Three-Digit Verification Code (on back of card) ___ ___ ___
Cardholder Name (print) ______________________________________________________________________
□ New □ Name □ Prior to 7/7/14
□ Readmit □ Address
□ Hold □ Phone □ After 7/7/14
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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