Outdoor Programs Application Request

Western Colorado University / Academics / Center for Learning & Innovation / Outdoor and Experiential Education Program Partnerships / Outdoor Programs Application Request

Outdoor and Experiential Education Program Partnerships

Outdoor Programs Application Request

Thank you for completing this form to request a registration packet for your program of interest. Please note that this form is not the registration packet. You will receive a packet by email after sending this request. Your enrollment is not complete with Western Colorado University until you receive a registration confirmation email.

Today's Date*
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Name*
First Last
Contact Number
Email Address*
Enter Email Confirm Email
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This address must match what will be used on your application form.
Select Your Program*
Course Start Date*
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Course End Date*
MM slash DD slash YYYY
Do you plan to use AmeriCorps or 529 Plan educational funding to pay for your course?*
- Yes - AmeriCorps
- Yes - 529 Plan
- No, I will not use educational funding; I am paying with cash, credit card, or check.
If you are using AmeriCorps funding to pay for your course, state the date that your award expires:
MM slash DD slash YYYY
Additional Comments or Questions
Comments
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Outdoor Programs Application Request