1. Print out and complete the registration form.
2.
Obtain the necessary supervisor approval (Staff only for selected
courses).
3. Send the registration form by campus mail or fax to:
Office of Information and Technologies Attention: Beverly Church Fax 574-520-4163
Please Note: only two classes per semester allowed.
Please print. Refer to the Continuing Education
homepage (http://www.iusb.edu/~cted) or
catalog for section numbers, class dates and times.
Section # Class Dates/Times _________ ____________________________________________ __________________ _________ ____________________________________________ __________________ Mr. ____ Ms. ____ Dr. ____
__________________________________________________________________ Name __________________________________________________________________ Position/Title __________________________________________________________________ Division or Department __________________________________________________________________ Campus Phone __________________________________________________________________ Division or Department Fax Number __________________________________________________________________ Home Phone
__________________________________________________________________ E-mail address (Please Print exact address, including capitalization)
__________________________________________________________________ Supervisor Approval (Staff only for selected courses) FOR OFFICE USE ONLY __________________________________________________________________ IT Authorization/Date