2004 - 2005 MLC Extension Course Application
Deadline for registering for courses is three weeks before start date.  Payment deadline is one week before start date.

     Last Name  E-mail Address

    First Name    Middle Name (Required)  Title

    Maiden Name   Male Female    Birthdate (m/d/y)

    Your Social Security Number will be requested on a registration card at your first day of class.

  Address CityStateZip(Required)

    Home Phone      Work Phone 

Racial/Ethnic Origin:

Black, Non-Hispanic  Native American or Alaskan Native 
Asian or Pacific Islander Hispanic
White, Non-Hispanic Other

 Did you attend Martin Luther College during the 2003-04 academic school year?YesNo

    Your enrollment status is

 If you checked Synodical Certification or Synodical Re-Certification, please indicate your Area of Study:

What was your last year of enrollment at: DMLC   MLC   NWC WLS

    If you are currently serving in a congregation, complete the following:

    Congregation      City/State  

What is your present occupation?

Are you a student at another institution? YesNo

If yes, what is the name of the institution?

What is your purpose for taking this course?

    Course Registration. Course tuition is $175 per credit.  

    Course 1:       

       Tuition and Special Course Fees:

Item Fees
Tuition (3 credits @ $175/credit) $525
Off Campus fee (REL4001) $50
Technology fee (REL9501) $50
Registration Fee  $10

   Upon receipt of your Extension Course Application, the Office of Continuing Education will calculate your tuition and fees and forward billing to the address given above.
   

  If you do not see a receipt for this application within a minute, please report the problem to : bauerdt@mlc-wels.edu                    Last updated 11-04-2004