The Arc Wisconsin Academy: Self-Pay by Credit Card

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 realtionship)
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
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
CAPTCHA

Contact Information