Isothermal logoContinuing Education

Online Registration Form

Isothermal Community College
Continuing Education Department
P.O. Box 804, Spindale, NC 28160

The Following Information Is Required By The N.C. Community College System
Social Security #  
Name: 

 
Last

 
First

 
Middle
Address:  
Street Name, Apt. # or P.O. Number		  
City		  
State		  
Zip Code
Email Address: (If applicable):
Date of Birth:   Gender: Male or Female
Race:
Highest Grade Completed: Passed high school equivalency (GED) Yes or No
County of Residence:
Home Telephone Number: Work Telephone Number:
Job Title:
Employment Status:
Place of Employment:
 
List Course Titles: Beginning Date Course # Section

 
If Fees Exempt, List Agency (i.e., Fire Department, Law Enforcement, Emergency Personnel)
 

If you are registering for the Safe Driving Course, please complete the following:

Citation #:

County where citation was issued:

Driver's License #

State where Driver's License was Issued:

What was the charge?


 

Some classes require pre-payment.  
For fastest service, please complete the following with your credit card information.

Please note:  this is not a secure transaction.  Your information will be transmitted via email to one of our staff for further processing.  As stated in our Privacy Policy, your privacy is very important to us and your information will be kept confidential and only used for the purposes which you authorize.  We never sell or give away any student or staff information.

Here's my credit card information:

 Credit Card Type:   Card No.:
 Expires:

Your Name as it appears on the card:

Please note:  this is not a secure transaction.

If you prefer to make other arrangements for payment, please indicate below.

Please contact me about payment arrangements.
 
Certification of Accuracy
 Yes or No
By Choosing "Yes", I certify to the best of my knowledge that the information given is true and complete. Further, I understand that by submitting this information via electronic transmission that I acknowledge the above statement of certification in lieu of a signature.

Date:

PLEASE NOTE: 
Selecting "SUBMIT" below indicates your consent for your computer's IP address to be recorded and sent to the recipient of the form email, in accordance with our Privacy Policy. This action is necessary to discourage abuse of our email system.

Continued email abuse determined to be caused by an individual will be regarded as a violation of the Computer Resources, Internet, and Network Use Policy and may result in loss of computer privileges and/or other disciplinary action.