JCPS - Adult & Continuing Education Registration Form- Do not use. You have received this form in error.                Please email -  msdcertifications@jefferson.kyschools.us


A separate form for each registration is required.

Please accept this enrollment for the course indicated. Payment can be made by using MasterCard, VISA, Discover, or American Express Credit or Debit card. If paying by check, mail to JCPS Adult & Continuing Education 546 S. First St., Room 206, Louisville, KY 40202 Attn: Terri Lindsey/Carol Ziegler. Please Note: Check refunds may take a minimum of 30 days to process.


Email Address - We will use this email address to send you the online course login information.
If business/billing  email is different please list as secondary email.
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Email *
Secondary Email - Business/Billing
Are you an MSD Employee?
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If yes  - your MSD Employee Email address is required
Course Title: EPSC Online courses are available 24/7.   *
Full Name on Card: *
Billing Address: Street/City/State/Zip
Business Phone Number: *
Credit/Debit Card Number *
CID - 3 Digit Code on back of Card *
Credit/Debit Card *
Expiration Date: Month/Year
Participant's Certification# If previously certified
Participant's Last Name *
Participant's First Name *
Participant's Date of Birth *
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Participant's Address: Street/City/State/Zip *
Participant's Phone Number: *
The above contact information will be used to notify participants regarding the requested course. In consideration of the above-referenced class, I hereby agree to release and hold the Jefferson County Public Schools and its staff free and harmless to any claims for injury or damage, which may result from such activity. I acknowledge that I give permission to MSD and the JCPS Adult Education Program/Louisville Learns Programs to share my certification information with the Permit Office and any related EPSC Ordinance entities. *
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Signature *
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