Complete this registration form and:

Mail To
Eastern Iowa Community College District
Attn: Registration
306 West River Drive
Davenport, IA 52801


Fax To
Clinton Community College - (563) 244-7053
Muscatine Community College - (563) 288-6116
Scott Community College - (563) 441-4053

Send a check or money order (no cash please) with the class number(s) and student's social security number written on the lower left hand corner. We will call you to confirm faxed registrations.

Tuition and fees are due at time of registration. Refunds will be issued if you cancel your registration three days prior to the start of a class.

Company Name or Vendor number:  
Day Phone: _____________________________________
Night Phone: ____________________________________
Social Security No. _______________________________
Prof. License No. (if applicable): _____________________
E-mail Address:
Class Title: ________________________________
     Class No.  ___________ Tuition/Fee: $________
Class Title: ______________________________________
     Class No.  ___________ Tuition/Fee: $________
Class Title: ______________________________________
     Class No.  ___________ Tuition/Fee: $________
Total: $ ________

Make checks payable to "Eastern Iowa Community College District" or use your Credit Card.

Please charge all fees to (check one):
Mastercard____ VISA____
American Express____ Discover____
Credit Card No. _____________________________________
Name on credit card (please print):
Expiration Date: __________
Signature: __________________________________________
Date:  ______________________________________________

I have read and understand the registration and refund procedures for Continuing Education.
Signature: __________________________________________
Date:  ______________________________________________

Every effort has been made to make this publication accurate as of the date of issue; however, all policies, procedures, tuition fees, and curriculum are subject to change any time by appropriate action of the faculty, the college administration or Board of Directors. This publication is not intended to be a contract, explicit or implied, and the college reserves the right to make changes in information contained herein.

Attendance - You must attend the complete offering and meet the program objectives to be eligible for contact hours or continuing education units/hours.

Refunds and Substitutions - If your plans change, you may cancel your registration up to three calendar days prior to the start of the program. After that, no refunds will be issued. You may however, apply the tuition toward another class that meets your scheduling requirements or you may choose a gift certificate in the amount of your class to use within one year of the date issued. Please note that if you don't cancel and don't attend, you are still responsible for payment.

Class Cancellation - Three days prior to the activity, a decision will be made by the college administration to run or cancel the program based on the number of individuals who have enrolled and paid.Each college reserves the right to cancel a class due to insufficient enrollment.

Postponing Classes Due to Bad Weather - In bad weather,classes may be postponed. This does not occur very often. Listen to local radio stations for college announcements.

Grievance Policy - If you have a problem or concern with any offering, please contact the Continuing Education Office at the college district.

Scott Community College Urban Centerand Kahl Education Center PARKING DIRECTIONS - Free two-hour parking is available on the streets around the Urban Center. Longer term parking is also available for students on class days. Stop at the Information Desk before parking to get a card to place on your vehicle dash. All downtown parking is free after 5 p.m. and on weekends.