r 1/17/12
WCS Non-credit Application
Attention: WCS • P.O. Box 10,000 • Toledo, Ohio 43699-1947
1-800-GO-OWENS, Ext. 7357 • Fax: (567) 661-7662
Attention: WCS • 3200 Bright Road • Findlay, Ohio 45840-3509
1-800-GO-OWENS, Ext. 3155 • Fax: (567) 429-3168
Please print information clearly with black or blue ink
Social Security Number: __________ - ______ - ____________
Your Social Security Number is confidential and protected by both federal and state laws. The college will protect this number from unauthorized disclosure
and/or use. In compliance with state and federal regulations/laws, disclosure may be authorized for the purposes of state and federal reporting.
Additionally, Owens Community College will use your Social Security Number for keeping records, and reporting. If your Social Security Number is
not provided, Owens Community College and other colleges may not be able to match your application(s), test scores or transcripts to your academic
records which may delay processing your application.
Gender: m Male m Female Birth Date: (MM/DD/YYYY) _________ / _________ / _________
Please print your name exactly as it appears on legal documents:
Last _________________________________________ First _______________________________________ Middle ______________________
Please indicate any former names:
Home Mailing Address (include apartment number or lot number if applicable):
Address: ______________________________________________________________________________________________________________
City: ________________________________________________ State: ______________________ Zip Code: __________________________
County: _____________________________________________ E-mail: __________________________________________________________
Home Phone: ________________________________________ Cell: _______________________________ Work: _______________________
Emergency Contact Name: _______________________________________________________________ Phone: ______________________
* An electronic notification system will inform you of any class updates provided we have correct and complete contact information.
Your responses to the following questions regarding race and ethnicity are voluntary and will be treated as confidential.
No discriminatory action will be taken as a result of your response and no adverse action will result if you do not respond.
Are you of Hispanic or Latino origin? m Yes m No
If you wish to be identified by race, please check one or more:
m American Indian/Alaska Native m Asian m Black/African American m Native Hawaiian/Pacic Islander m White/Caucasian
The information given above is complete and accurate to the best of my knowledge. I will be responsible to pay all fees, interest, and expenses
incurred. Delinquent accounts will be forwarded to the Ohio Attorney General’s Ofce for actions, as required by the Ohio Revised Code. Successful
completion of a program of study at the College does not guarantee licensure, certication, or employment in relevant occupation.
By signing this application, I agree to abide by all policies, regulations, and procedures of the College. I understand this application is for non-credit
coursework only.
______________________________________________ ______________________________________ ______________________________
Please Print Student Name Signature Date
______________________________________________ ______________________________________ ______________________________
Please Print Parent Name Signature Date
Under the age of 18, Parent or Legal Guardian Signature required
Owens Community College promotes equal opportunity regardless of age, color, disability, national origin, race, religion or sex.
Method of Payment
m Check or money order enclosed (made payable to Owens Community College)
m Company purchase order enclosed: P.O. # ___________________________________
P.O. Billing Address _______________________________________________________________________________________________
If paying by credit card, please call our office at (567) 661-7357.
CRN Credit Hours
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