Fall 2013 Registration Form

Please register at least two weeks before course start date

1. Course Number & Title:
2. Name: First Last:
3. Home Phone: - -
4. Work Phone: - -
5. Address: Street:
City: State:   Zip:
6. Have you EVER taken a WCU course? Yes No
7.Gender: Male Female
8. WCU ID:
If you do not know your ID #, or if this is your first WCU course, enter 0000000
9.Date of Birth: Month: Day: Year:
10. Residence County:
11. Citizenship Country:
12. Cell Phone: - -
13. Email Address:
Please include a regularly accessed e-mail for purposes of confirmation and contact with instructors.

 Do you want to receive the PAWLP electronic Newsletter at this e-mail address? Yes No
14. Grade(s) Level presently taught:
15. Job Title:
16. School District:
17. Building:

Costs:

Tuition and fees TBD in July, 2013

Payment Methods:
18. Check or money order #:
19. Check amount.
Your phone number should be on your check or money order. Make check payable to West Chester University.
20. Credit card: The University accepts Mastercard, Discover, and American Express. Credit card payments must be made on-line at myWCU and are subject to a 2.75% fee.

Please check here if you will pay on-line by credit card.
You must be registered for the course before you can pay on-line.
 
For more information, call 610-436-2202
Visit the PAWLP Website http://www.pawlp.org