First Name*
Student ID or Social Security Number
Phone
(###-###-####)
Mailing Address*
(Street)
Date of Birth*
(mm/dd/yyyy)
All fields with an asterisk (*) must be completed. Social Security Numbers are used for record keeping and statistical purposes and are kept in strict
confidence. Privacy information is available at: madisoncollege.edu/ferpa.
Former Name(s)
Last Name*
Middle Initial
City*
State*
Zip Code*
Apartment
P.O. Box
Add classes using the fields below. In case first choices are filled/closed, include second choices. Review carefully to prevent scheduling conflicts. Check
class availability at: programs.madisoncollege.edu/allcourses.php. This form cannot be used to add classes after the class start date. All other requests
will be considered void. Auto enroll occurs as space becomes available, up to 2 days prior to class start date.
Students enrolled will be responsible for all tuition and fees. Monitor class schedule to confirm enrollment.
Part 3 - SIGNATURE & AGREEMENT
Signature
Date
By signing and submitting this form, I certify that I agree to Madison College's payment policies related to the registration above. In the event that I fail to timely comply with the payment obligations of Madison
College, I agree to pay all collection costs incurred by Madison College. I understand Madison College may certify any past due balance I incur to the Wisconsin Department of Revenue (WDR) and make a claim for
the total due against refunds, overpayments or lottery winnings owed to me by the WDR.
First Choices:
Class Number
(5 digits)
Class Title
Campus/Location
Add to waitlist if
full?
Yes
No
Yes
No
Yes
No
Yes
No
This form should be used only as an
alternate method of registration.
Individuals who use online or in-person
registration service will receive
confirmation of enrollment during
the transaction. Therefore, a class
may fill prior to the processing of
mail or fax registrations.
See page 20 for preferred registration
methods and instructions for online,
telephone and in-person registration.
Complete the form and mail to:
Madison College Continuing Education
1701 Wright Street
Madison, WI 53704-2599
Fax: (608) 828-7906
Allow 14 business days to process
Registration Request. Requests are
reviewed in order they are received.
Monitor class schedule from your
myMadisonCollege Student Center.
Questions? For assistance, contact
Continuing Education at (608) 258-2301
or 1-800-322-6282.
Second Choices:
Class Number
(5 digits)
Class Title
Campus/Location
Add to waitlist if
full?
Yes
No
Yes
No
Yes
No
Yes
No
Part 1 - STUDENT INFORMATION
DIRECTIONS:
Part 2 - REGISTRATION
Preferred Email Address
Cut here
Fall 2013
registration form
Noncredit Classes
Madison Area Technical College
Online:
madisoncollege.edu/ce
madison Campuses:
Downtown Education Center
211 N Carroll St., Madison
Truax Campus
1701 Wright St., Madison
(608) 246-6100
Truax Health Building
1705 Hoffman Street, Madison
Madison College South
Villager Mall, 2338 S. Park St.,
Madison College West
302 S. Gammon Rd., Madison
Commercial Ave Education Center
2125 Commercial Ave., Madison
Other locations:
Dale Heights Presbyterian Church
5501 University Ave., Madison
Madison Senior Center
330 West Mifflin St., Madison
McFarland High School
5104 Farwell St., McFarland
Middleton High School
2100 Bristol St., Middleton
Middleton Senior Center
7448 Hubbard Ave., Middleton
Monona Community Center
1011 Nichols Rd., Monona
Monona Senior Center
(Ground Level)
1011 Nichols Rd., Monona
Plain GreenTTEC
1110 Leed Parkway, Plain, WI
Stoughton Lakeview Church
2200 Lincoln Ave., Stoughton
Stoughton Senior Center
248 W Main St., Stoughton
Sun Prairie Colonial Club
301 Blankenheim, Sun Prairie
Verona Senior Center
108 Paoli St., Verona
St. John's Catholic Church
209 South St., Waunakee
Waunakee High School
301 Community Dr., Waunakee
Waunakee Senior Center
333 S. Madison St., Waunakee
Waunakee Village Center
333 S. Madison St., Waunakee
Westminster Presbyterian Church
4100 Nakoma Rd., Madison
Wisconsin Heights Middle School
10173 Hwy 14, Mazomanie
madison College locations
Real world smart.