The Arc Wisconsin Academy: Registration Through the Family Care Program

Contact Information
Student name*
First Last
Student email*
Student phone*
Another person who is supporting me to enroll in this course:
- Yes
- No
Supporter's name
First Last
Supporter’s email address:*
Supporter’s relationship to the student:
- Parent
- Sibling
- Other relative
- Support professional
- Other (please specify)
Other (Supporter's relationship)
By enrolling in this course, you verify (you must check all boxes)*
- I have internet access
By enrolling in this course, you verify (you must check all boxes) - option 2*
- I have a computer or tablet that will allow me to join an online course
By enrolling in this course, you verify (you must check all boxes) - option 3*
- I will access recordings of classes if I am unable to attend a live course (courses will generally be held the second Monday of the month in the afternoon or second Tuesday of the month in the morning.)
I am interested in the following course*
- The Arc Wisconsin Academy Annual Fee to attend both courses (12 classes + bonus class): $475
- HealthMatters™ Course starting April 12, 2021 (six classes, each class offered 2x/month): $240
- Self-Advocacy Leadership in Action Course starting October 2021 (six classes, each class offered 2x/month): $240
Name of Family Care Care Manager*
Family Care Organization (MCO):*
- My Choice Wisconsin
- Community Care, Inc.
- Inclusa, Inc.
- Lakeland Care, Inc.
- iCare
Has Family Care approved your participation in The Arc Wisconsin Academy?*
- Yes, Family Care has already approved payment for this program
- No, but I will submit The Arc Wisconsin Academy for approval
We cannot confirm that you are enrolled in the course until payment is verified. You will receive your course materials when your payment is verified!
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