Continuing Education Online Registration Request

Legal First Name*

Middle Name

Legal Last Name*

Birthdate*

Ethnicity*

Hispanic/Latino

Non Hispanic

Select One or More Races

Hispanic/Latino

Asian

Black or African American

Hawaiian/Pacific Islander

White

Gender

Male

Female

Highest Education Completed

Employment*

Mailing Address*

Apartment/Suite

City*

State*

Zip*

Email Address*

Phone Number*

Phone Type*

Home

Work

Cell

Which types of classes are you interested in?To select multiple options, on a Windows computer hold the Control key, on a Mac hold the Command key

Course Number*

Have you taken a class with us before?*

Yes

No

Student ID Number

Registration Fee Requirement*

I understand that payment for a class is required by the deadline date for registration.

Registration Fee Exemption(s)

NC Fire Department Personnel

NC Law Enforcement Officers

NC Rescue EMS Personnel