CACC - PCE Enrichment Course Catalog Fall 2018 | Page 23

Register Online • www.career-center.org/pce ■ Phone 573-214-3803 8am-4pm [M-F] ■ Walk-Ins 4203 S Providence Rd. 8am-4pm [M-F] ■ Fax 573-214-3811 [Include form below] [Main South Entrance] ■ Mail 4203 S Providence Rd. Columbia, MO 65203 [Include form below] INFORMATION Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date. . . . . . . . . . . . Street. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . City. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State. . . . . . . . . . . . . . Zip. . . . . . . . . . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Email. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Birth Date [DD/MM/YY]. . . . . . . . . . . . . . . . . . . . ❍ Male ❍ Female Course Selection Course # Course Title Fee TOTAL $ PAYMENT METHOD Choose One: ❍ Credit Card ❍ Check: Payable to Columbia Public Schools ❍ ❍ ❍ Name on card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . Credit card number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . Expiration date. . . . . . . . . . Security code [3-digit code on back] . . . . . . . . . . . . . . . . . . Signature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . The Columbia Public School District does not discriminate on the basis of race, color, religion, gender identity, gender expression, sexual orientation, national origin, ancestry, disability, age, or use of leave protected by the Family and Medical Leave Act, in its programs, activities, or with regard to employment. The Columbia Board of Education is an equal opportunity employer. Inquiries regarding Columbia Public Schools’ compliance with IDEA and Section 504 regulations should contact Special Services at 1818 West Worley, Columbia MO, 65203 (573) 214-3462. Columbia Area Career Center is committed to providing equal access educational opportunities for students with disabilities covered under The Americans with Disabilities Act. The objectives are to ensure that students with disabilities function adequately and without discrimination in all aspects of the educational experience. Accessible facilities are available at all training locations. Students with documented disabilities who would like to inquire about the availability of reasonable academic and/or other program related accommodations should contact the Section 504 Liaison, 214-3800 ext. 29401.