Enrollment Form - Short-Term Classes - Fairview Campus

Adult Training and Development Course Enrollment Form

Please click submit at the bottom of the form after completing the information. A Northwest Technology Center representative will then contact you to verify your enrollment and request payment information.

**Notice: You are not guaranteed to be enrolled in the course until payment is received and confirmed.**

Enrollment Procedures

First Name: Middle Initial:
Last Name:
           
Street Address:    
Email:
           
City:
State:
Zip Code:
           
Home Phone:
Work Phone:
           
Employer:
Address:
 
           

Primary Reason for Enrolling:

Learn new skill
Upgrade or improve existing skill
Other reason (please specify)

Courses Requested:

Course Title: Dates:
       
Course Title: Dates:
       
Course Title: Dates:
       


 

Contact Information

For questions about short-term classes at the Fairview campus, contact Steve Kliewer by phone at 580.227.3708 or by email at skliewer@nwtech.edu or Susan Bymaster by phone at 580.227.3708 or by email at sbymaster@nwtech.edu.

Updated on 6/17/12