COURSE/CPDU OPPORTUNITIES
Course Information
Course Name
Course Number
 Section Number Semester
Student Information
Last Name
First Name
 Middle Initial Social Security No.
Street Address
City
State
 Zip Code
Date of Birth
Sex
Phone Numbers/Email
If you do not wish to submit this information electronically, you may return this registration form by mail to:

Dr. Denise M. Crews, Director
Developmental & Educational Programming
John A. Logan College
700 Logan College Road
Carterville, IL 62918

You may fax using this number: (618) 985-3899
(618) 985-2828, extension 8566 or 8583

denisecrews@jalc.edu

karensemanski@jalc.edu

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