Howard College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The following person has been
designated to handle inquiries regarding the non-discrimination policies: Director of Human Resources, 1001 Birdwell Lane, Big Spring, TX 79720, 432-264-5100
HOWARD COLLEGE – BIG SPRING
WORKFORCE TRAINING/CONTINUING EDUCATION
1001 Birdwell Lane Big Spring, TX 79720
(432)264-5131 Fax (432)264-5189
PLEASE PRINT CLEARLY
COURSE NAME: __________________________________________________ COURSE DATE(S):_____________________________________
HC STUDENT ID OR SOCIAL SECURITY#: _________________________________________________________________________________________________
NAME:
LAST FIRST MI
ADDRESS:
STREET CITY STATE ZIP
PHONE NUMBER: Hm: Wk: *Birth Date:
EMPLOYER NAME: _____________________________________________ EMAIL: _______________________________________________________________
ETHNIC GROUP: (WHITE, HISPANIC, AFRICAN-AMERICAN, etc.) MALE: FEMALE:
ARE YOU A VETERAN? DO YOU HAVE CHILDREN UNDER 16 YEARS OF AGE?
DO YOU HAVE A HS DIPLOMA or GED? MA NUMBER (Required if Renewing Med Aide Permit): __________________________
STUDENT DATA UPDATE FOR GOVERNMENT REPORTS
Please check YES or NO to the following questions.
1. Are you enrolled in a developmental class or Adult Basic Education (ABE) because of TASP
YES
or placement scores?
2. Are you receiving Pell Grant or other Federal assistance?
3. Do you have a disability which substantially limits a major life activity?
YES NO
4. Do you have difficulty speaking or understanding inst
ructions in the English language?
YES
NO
5. Are you a homemaker no longer supported by public assistance and having difficulty obtaining
Employment?
YES
NO
6. Are you a single parent?
NO
THIS BOX IS FOR HOWARD COLLEGE USE ONLY:
WECM#: COURSE: ROOM: __________________________
INSTRUCTOR: CLASS DAYS: TIMES: _
1st CLASS DAY: 3rd CLASS DAY: FINAL: _______________________
I understand I can withdraw from the class under the following Continuing Education guidelines for withdrawals:
1. Prior to the first class day 100% refund
2. Prior to the second class day 70% refund
3. Second class day and beyond 0% refund
The withdrawal process includes contacting the Continuing Education office or the Registrar’s Office during business hours to complete an official drop slip.
Please sign and date below indicating that you have read and understand the guidelines for withdrawal
“Education…For Learning, For Earning, For Life!”
Signature: ______________________________________________________________ Date: _______________________________________
YES
YES
NO
NO
NO
NO
NO
YES
YES
YES
*Signature may be typed
