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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 Dental, Phlebotomy, CNA, and DWI 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.
 
Course Information:
 
Course ID
Course Title
Room
Beginning
Ending
Days
Time
Hours
i.e. ITNW1007V301
i.e. First Aid
 
Month
Day
Month
Day
 
From
To
 
-
-
-
 
Personal identification and contact information:
 
First Name:
Last Name:
Middle Initial:
Social Security Number:
E-Mail Address:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
 
You must select a goal and answer the residency questions:
 
Goal for Attending:
Get a Job
Improve Skills Needed in Current Job
Retrain for a New Skill
Maintain Licensure
Personal Enrichment
Other (or none of the above)
Residency Status:
Have you been a resident of Texas for the last 12 months?
Yes
No
If YES, what county?
If NO, in what state did you previously reside?
 
Sex, birthdate, age and ethnic information must be entered:
All information given is considered confidential and will be used for reporting purposes only.
 
Sex: Male Female
Date of Birth (MM/DD/YYYY):
Age:
Ethnic:
White Non-Hispanic
Black Non-Hispanic
Hispanic
 
Asian/Pacific Islander
American Indian/Alaskan Native
Non-Resident Alien
 
Check all other boxes that apply to you:
Single Parent
Homemaker
Veteran
Hazelwood
Non-traditional Student
Dislocated Worker
High School Graduate
GED
Limited English
Economically Disadvantaged
Hearing Impairment
Speech Impairment
Mobility Impairment
Visual Impairment
Emotional Dysfunction
Learning Disability
 
Payment Information:
 
Type of Card:
Name on Card:
Card Number:
Exp. Date:
Tuition Amount:
$
 
 
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.
 
Please Note the refund policy for the Basic and Advanced Motorcycle courses are different.
 
Request for refund or transfer must be received at least one week 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.