First Name*
Student ID
Phone
Email Address
(###-###-####)
Mailing Address*
(Street)
Date of Birth*
(mm/dd/yyyy)
All fields with an asterisk (*) must be completed.
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 fi
lled/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 schedul
e 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 regist
ration 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 Wisconsi
n 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 11 for preferred registration
methods and instructions for online,
telephone and in-person registration.
Complete the form and mail to:
Madison College Continuing Education
330 West Collins Street
Portage, WI 53901
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
Spring 2014
noncredit Mail-in Registration Form
Madison Area Technical College
Madison College
Portage
330 W. Collins st.
Portage, Wi 53901
608-745-3100
Portage Enterprise Center
1800 Kutzke rd.
Portage, Wi 53901
Woodridge Elementary
333 E. slifer st.
Portage, Wi 53901
Columbus area
senior Center
125 north dickason Blvd.
Columbus, Wi 53925
Madison College
reedsburg
300 alexander ave.
reedsburg, Wi 53959
608-524-7800
Webb Middle school
707 n. Webb ave.
reedsburg, Wi 53959
Baraboo high school
1201 draper st.
Baraboo, Wi 53913
Plain green ttEC
1110 leed Parkway
Plain, Wi 53577
Portage, Reedsburg and Plain College Locations