Registration Form for Faculty Quality Assurance System Courses
Please complete the registration form and mail with your check payable to NTC 
$150 NTC Employees           $200 for all other students 

Upon successful completion NTC employees will receive a refund of 50% if full-time and 100% if adjunct faculty.  Please indicate which college you are affiliated with. There will be no refund for non-completers.

PLEASE PRINT
							
NAME	     	SOCIAL SEC. #  OR    
NTC Student ID #	     			
ADDRESS	     	DATE OF BIRTH	     			
CITY	     	STATE	     	ZIP	     	
CELL/WORK PHONE:	     	Adjunct or Full time instructor? 	     			
E-MAIL ADDRESS:	     	College You Work For:	     			

CLASS  #	Course Name & Course #	Start Date	Fee	
     	     	     	     	
     	     	     	     	
Total fee payment is due with when registration is submitted.	Total	     		
  Paid: Check#         		
Credit Card: Card Type:	     	
Card #:	     	
Exp Date:       Month / Year	     	

Return with payment to:     Northcentral Technical College
				     Quality & Continuous Improvement Office, “WW”
				     1000 W. Campus Drive
               			     Wausau, WI  54401
				     E-mail:  QCI@ntc.edu

*LENGTH OF TIME FOR COMPLETION* Deadline for course completion is within the semester of registration 
UNLESS OTHERWISE NOTED BY YOUR FACILITATOR. CHECK COURSE INFORMATION IN BLACKBOARD. 
If the activity is not completed within the semester, the registration fee will be forfeited and you will be dropped from the course.

FALL=August 24 – December 15, SPRING=January 25 – May 20, SUMMER= June 1 – July 31 

**Please note: During the NTC College Shutdown weeks in December and July your facilitator may be unavailable.