Rock Creek Welding Wait List Form

All fields must have an entry. If you do not have a "G" number (PCC Student ID), and PCC email address, you will not be put on the wait list. You must complete the PCC Admissions process at which time you will be given a "G" number and PCC email address.

1. Student Information Last Name: First Name: Student ID (G#): Home Phone: Cell Phone: PCC Email: Term Year:

Term: Winter (January) Spring (April) Summer (June) Fall (September)

2. Availability Check all available day shifts that apply:

Monday through Thursday: Morning 7am-12 noon Afternoon 12 noon-5pm Evening 5pm-10pm

Friday: Afternoon 12 noon-8pm

Columbia County: Monday through Thursday Evenings 6pm-9pm

3. Goal Select your goal:

Associates of Applied Science Welding Certifications

Less Than One-Year Certificate of Completion Individualized Instruction

4. Attended Experience Have you attended welding classes at PCC with in the last two years?

Yes

5. Agreement

I understand that I am on the wait list, and not registering for a welding class. I also understand that I will have 24 hours to respond when an instructor calls me to be enrolled into a welding class(es). I also understand that it is my responsibility to contact the welding program to notify them if my personal information changes.

I Agree: