REGISTRATION FORM
Make checks payable to NWTC. Print all information using black ink only.
Student Number
National ID (SS#)
Last Name
City
Legal
Resident
of:
Home Telephone
Area Code
Middle Initial
Previous Last Name
Male
Female
Street Address
Area Code
First Name
Visit our Web site at ...
www.nwtc.edu
Work Telephone
Area Code
State
Zip Code
Town
o1. American Indian/
Check one:
o U.S. Citizen
oImmigrant
o Nonimmigrant
Required Government Statistical Information
County
Village
Cell Phone Number
City
o4. Hispanic
o5. White, Not Hispanic
o6. Native Hawaiian/
Alaskan Native
o2. Asian
o3. Black, Not Hispanic
Date of Birth
Other Pacific Islander
o HSED _______
Education: Name of High School
Disability:
Yes
No
|
City
State
Check ‘Yes’ if you are self identifying a disability.
Class Number
Class Title
Catalog Number
High School
Year
Graduated
Start Date
Highest
Grade Completed
oGED® _______
Year Completed
Class Fee
Out-of-state residents may be
responsible for additional fees.
The College reserves the right to cancel classes in the event of insufficient enrollments. If a class cancels, you will be notified prior to the starting date.
GED® and GED Testing Service® are registered trademarks of the American Council on Education® and may not be used or reproduced without the express written permission of the American Council on Education.
PUBLIC SAFETY
NON-PROFIT
ORGANIZATION
U.S.
POSTAGE PAID
Permit No. 162
GREEN BAY, WI
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 West Mason Street
P O Box 19042
Green Bay, WI 54307-9042
ADDRESS SERVICE REQUESTED
Spring 2015
Register early to avoid disappointment!
Pre-registration is necessary
ACLS Course Schedule
Visit our web site at www.nwtc.edu
SPRING 2015
ACLS Course Schedule
Visit our web site at nwtc.edu
Toll-free 888-385-NWTC
ACLS PROVIDER
Each provider course (Catalog # 47-531-462; Course ID 25073) meets on the Green Bay Campus in the Corporate
Conference Center (NW corner of campus on the first floor) unless otherwise noted.
Time
Hrs
Location
Site/Rm
Class #
Start
End
Days
20
Green Bay
St. Vincent HospitalHeritage Conference Room C
25494
1/16/15
1/23/15
F
20
NWTC-Green Bay
CC 120/121
25548
2/9/15
3/9/15
M
5PM-9PM
20
Iron Mountain
Dickinson Memorial Health Systems
25549
3/25/15
3/26/15
W&R
8AM-6PM
8AM-6PM
ACLS RENEWAL
Each renewal course (Catalog # 47-531-462; Course ID 58724) meets on the Green Bay Campus in the Center for Business
and Industry Building (NW corner of campus) unless otherwise noted. Please come fully prepared to complete the renewal
and test on the day of the course.
Time
Hrs
Location
Site/Rm
Class #
Start
End
Days
8
NWTC-Green Bay
CC 120/121
25551
1/12/15
1/19/15
M
5PM-9PM
8
NWTC-Green Bay
CC 120/121
25552
1/26/15
2/2/15
M
5PM-9PM
8
Green Bay
St. Mary’s Hospital Basement Conference Room C
25597
2/6/15
2/6/15
F
8AM-4PM
8
NWTC-Green Bay
CC 120/121
25553
3/16/15
3/23/15
M
5PM-9PM
8
Iron Mountain
Dickinson Memorial Health Systems
25598
3/27/15
3/27/15
F
8AM-4PM
8
NWTC-Green Bay
CC 120/121
25554
3/30/15
4/6/15
M
5PM-9PM
8
Sturgeon Bay
Door County Memorial Hospital
25606
4/3/15
4/3/15
F
8AM-4PM
8
Green Bay
St. Mary’s Hospital Basement Conference Room C
25607
4/10/15
4/10/15
F
8AM-4PM
8
NWTC-Green Bay
CC 120/121
25555
4/13/15
4/20/15
M
5PM-9PM
8
Shawano
Shawano Medical Center
25608
4/16/15
4/16/15
R
8AM-4PM
8
Green Bay
St. Vincent Hospital Heritage Conference Room C
25609
5/8/15
5/8/15
F
8AM-4PM
PREREQUISITE: Familiarity with ECG Interpretation
and Cardiovascular Pharmacology. Physicians,
Physician Assistants, Registered Nurses, Paramedics,
RTs and Dentists only.
TEXTBOOK: “ACLS Provider Manual” for ACLS
Provider Course available in the NWTC Bookstore.
Price is approximately $43.00 plus sales tax. All
participants must have a current textbook for the
ACLS Provider and Renewal courses.
COURSE FEES: Payment, made payable to NWTC,
and should accompany all registrations.
ACLS PROVIDER FEES: Course cost is
approximately $145.00, includes course fee, and
American Heart Association fee.
ACLS RENEWAL FEES: Course cost is
approximately $105.00, includes course fee and
American Heart Association fee.
REGISTRATION DEADLINE: One week prior to
start of course so additional course information
can be mailed. Registrations received after the
maximum class size is reached will be returned.
REGISTRATION
ONLINE Registration
Use my.NWTC to access online registration and other services.
All you need is your Social Security Number or Student ID.
Please have a credit card available for
payment of all non-credit classes.
1.Go to http://www.nwtc.edu
2.Click the my.NWTC button below the NWTC logo.
3.Enter your User ID and password or follow the on-screen
instructions to createan account.
NOTE: When you see your Student ID and choose a
password, write them down – you will need them!
4.Once you are logged in to my.NWTC, select “Student Center”
near the top of your screen, then the “Search for Classes”
button on the right.
To protect your privacy, we may need your permission to
“reactivate” your account. For immediate activation, please
call 920-498-5444 or 888-385-NWTC during the “Green Bay
Hours” listed. We regret any inconvenience, and we look
forward to serving you!
Training Coordinators, register
your organization online!
Go to: My.Organization at NWTC
NWTC
accepts
Phone-In Registration
To register with one of our friendly Enrollment Services staff,
please call: (920) 498-5444 or (888) 385-NWTC.
Please have your Student ID and a credit card available
for payment of all non-credit classes.
Mail-In Registration
Registrations are processed by
postmark dates. Checks should be
made payable to Northeast Wisconsin
Technical College and mailed
WITH REGISTRATION FORM to: Northeast Wisconsin Technical College
P.O. Box 19042,
Green Bay, WI 54307-9042
Walk-In Registration
Register at – NWTC Green Bay Campus, enter off Country
Club Road and come to our Welcome Center, on Level 2 of the
Student Center.
Authorization to Bill: Enroll online through My.Organization
or contact Margaret Quam, at 920-498-6976 or
800-422-6982 Ext. 6976
Questions? Please contact Tammy Duescher, Public Safety
Division, at 920-498-6240 or 800-422-6982 Ext. 6240
NWTC does not discriminate on the basis of age, race, color, disability, sex, national origin, or other protected class. 44173PS nd 12_14