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Continuing Education Online Application (non-credit)

Submitting the registration form does not guarantee a place in the class. In the case that a class is full or more information is requested, Iowa Lakes will inform you through email or by telephone. 
 

Indicates a Required Field
Course #1:
Course #1 Name:
Course #2:
Course #2 Name:
Course #3:
Course #3 Name:
Last Name:
First Name:
Middle Initial:
Home Mailing Address:
City:
State:
Zip:
Home Phone:
Day Phone:
Alternate Phone (if available):
Date of Birth:
Social Security Number OR last four digits:
Gender:
Male
Female
Ethnic Background (optional - please check one):
Asian or Pacific Islander
American Indian or Alaskan Native
Black Non-Hispanic
Hispanic
White Non-Hispanic
Other
Email Address:
Professional License # (if applicable):
Type of License:
Payment Option I plan to use::
Call 800-252-5664 or 712-362-7231 with credit or debit card number (VISA, MasterCard or Discover)
Mail check to Iowa Lakes Continuing Education(include student’s name & course number)
Stop in at any Iowa Lakes business office
Payment will be made by a sponsoring party. (If so, the following information must be provided)
This class is free
Name of Sponsoring Party:
Sponsoring party street address:
Sponsoring party city:
Sponsoring party state:
Sponsoring party zip code:
Verification Code:
Questions or comments? Please email us at info@iowalakes.edu or call 712-362-2604 or 800-521-5054.
Copyright © 1996 - 2014 by Iowa Lakes Community College. All rights reserved.