Nicolet College Food Manager Continuing Education Registration Form
PLEASE PRINT.
First Name MI Last Name Social Security # or Nicolet Student ID #
Home Mailing Address City State Zip
/
/
Phone: Home
County of Residence Municipality of Residence Date of Birth
(Township/Village/City)
Gender: Male Female Email Address
THE FOLLOWING INFORMATION IS FOR STATE REPORTING PURPOSES. INFORMATION PROVIDED WILL NOT INFLUENCE COURSE ADMISSION.
Ethnicity: Are you Hispanic or Latino (regardless of race)? Yes No
Race: (Check all that apply) American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
Highest Educational Grade/Level Completed: 9 10 11 12 (includes GED/HSED) 13 14 15 16 (Bachelor’s Degree) 16+
What is the highest level of credential you have earned? No Credential GED HSED HS Diploma
Some College
Short Term Diploma 1 Year Diploma
2 Year Diploma Associate Degree Associate Degree + Additional Credential
Baccalaureate
More than Baccalaureate
Please check which class you prefer and include class date. Class Date Class No. Day Time Location Fee/Sr. Fee*
Food Manager Sanitation FULL DAY
8:30 am – 6 pm
$65 or
62+ 30.27
Food Manager EXAM ONLY
4 pm - 6 pm
$35 or 62+$28.05
Please check if materials are needed.
Materials will be mailed to the address above upon registration.
BOOK Servsafe 7th ed. includes scantron
$114.75
SCANTRON test answer Sheet ONLY
$43
FEES ARE DUE WITH REGISTRATION *Senior Fees for person age 62+ are available for Continuing Education classes only
Office Use Only
Phone: Cell Work
PAYMENT INFORMATION: _____ Check/Money Order (payable to Nicolet College) _____ Credit card
_____ Mastercard _____ Visa _____ Discover
___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Card Number
___ /___ Expiration Date ___ ___ ___ Verification Code (on back on signature panel)
__________________________________________ Card Holder Name/Signature
For more information: 715-365-4544 or email ce@nicoletcollege.edu
Mail or Email completed forms to:
jfox@nicoletcollege.edu
N
icolet College
Ce Registration
PO Box 518
Rhinelander, WI 54501