Home Health Care Registration Form

Please use this form to enroll students in Literacy First classes. You must complete all sections of the enrollment form to ensure enrollment in the class of your choice.

 

Course #*:          Location*:         

Dates*: 

Name*:         

Social Security Number*: 

Home Address*:         

Home City*: 

Home State*:          Home Zip*: 

Home Phone*:         

Work Phone*: 

E-mail Address*:   

Work Name*: 

Work Address*:         

Work City*: 

Work Zip*: 

Payment Method





 


Payment must be
received prior to class date.
Mail to: ECU
1100 E. 14th St. E-3
Ada, OK 74820
Fax: (580) 310-9007
Phone: (580) 559-5465
Email:ltilley@ecok.edu
 

Refund Policy: If enrollment is withdrawn 48 hours prior to first class, a full refund minus $20.00 processing fee or class credit will be given. If notification is received less than 48 hours, a partial refund of 1/2 class tuition will be refunded.

Thank you for submitting the following information.  You will receive a confirmation letter from us 2-3 weeks prior to the class starting.  If we can not get you enrolled in the class requested, we will call or email you to let you know the situation.  If you have questions or concerns please contact Lindsey Tilley.  Thank you for registering online for Literacy First.