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.