Registration form for UW certificate program:
C Programming 2008-2009 (Program ID# 2906)

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You may use this form to register for the UW Certificate Program in C Programming. Please print, complete and mail this form with your required materials to the address below.

Upon registering for the first-term course(s), you are considered a certificate program student who plans to participate in all courses of the program. Students are registered on a first-come, first-served basis until the program reaches its enrollment limit, or until 5 p.m. on the first day of class, October 1, 2008.

(You may also register using VISA or MasterCard by telephone at 206-543-2310 or 1-800-543-2320.)

C Programming: Introduction (Reg.# 95444)	$ 630
Registration fee	$   35
Certificate program fee	$   50
Total enclosed	$ 715

It is the applicant's responsibility to make sure that all required materials are submitted with the application. All applicants will be evaluated on the basis of materials submitted.

Mr.    Ms.
Last name:
First name/middle initial:
Social Security # (required):
Date of birth:
Mailing address:
City/State/Zip:
Daytime phone:
E-mail address:

Method of payment:

	Check in U.S. funds made payable to the University of Washington. (Returned checks are subject to a $25 service fee.)
	Third-party payer: separate document (purchase order or letter of authorization to bill) must accompany this form.
	VISA
	MasterCard

Card number:
Expiration date:
Name as it appears on card:
Credit card billing address:
City/State/ZIP:
Signature: