ALL STUDENTS—SECTION 1—ALL STUDENTS
Student ID Number
Last Name (Please Print) First Middle
Mailing Address No. & Street, Route & Box or P.O. City State Zip
List All Previous Names Here Birthdate: Mo./Day/Year Program/Major
Clearly Print Class Schedule
Item No. Sec
Circle Days
Credit
Beginning
Time
InstructorRoom
M T W Th F
M T W Th F
M T W Th F
M T W Th F
M T W Th F
M T W Th F
M T W Th F
M T W Th F
M T W Th F
Total
Credits
NEW STUDENTS: YOU MUST COMPLETE ALL QUESTIONS ON THE REVERSE SIDE OF THIS PAGE, IF YOU HAVE NOT COMPLETED AN APPLICATION FOR ADMISSION!
BBC 30-18 (10/15)
REFUND POLICY
Please see the class schedule
page on the BBCC website for
complete refund information.
Course
Dept. Number
What is your main long term goal for attending this community college?
(Check one box))
11 Take courses related to current or future work. 14 Explore career direction.
12 Transfer to a four-year college. 15 Personal enrichment.
13 High school diploma or GED. 90 Other.
Big Bend Community College—Class Registration Form
Ending
Time
E-mail Address Phone-Day ( ) Phone-Evening ( )
Please answer this question the first time you enroll at BBCC.
Do you have a physical or mental impairment which substantially limits one or more major
life activities, such as seeing, hearing, speaking, walking, learning, working, etc.?
Yes No
*Grading
Option
see instructions
Advisor's Signature:
X
Date
*Grading Option Column:
Leave this column blank if you want a decimal grade for
this course.
Put a "P" in this column if you want this course graded
on a Pass/Fail basis.
Put an "A" in this column if you want to audit (no credit/
no grade) this course.
Quarter of Registration Summer Fall Winter Spring 20______
Student Status New Returning
Terminal________________________
OFFICE USE ONLY
Terms: It is your responsibility to know college
enrollment policies, procedures, and deadlines.
Unpaid balances may be subject to collections and
you may be responsible for any collection & legal
fees. Your signature affirms that you agree to these
terms.
Student's Signature:
X
Date
click to sign
signature
click to edit
NEW STUDENTS— SECTION 2—
NEW STUDENTS
Male
Female
If not a U.S. Citizen, what
is your immigration status?
Student (F-1) Immigrant/Permanent Resident (IM)
Refugee(RF) Other
How long do you plan to attend Big Bend Community College?
Select the number that BEST applies to you and check that box.
11— One quarter.
12— Two quarters.
13— One year.
14— Up to two years, no degree planned.
15— Long enough to complete a degree.
16— Do not know.
90— Other.
What is your current work status while attending college?
Select the number that BEST applies to you and check that box.
11— Full-time homemaker.
12— Full-time employment (including self-employed and military).
13— Part-time off-campus.
14— Part-time on-campus.
15— Not employed, but seeking employment.
16— Not employed, not seeking employment.
90— Other.
What is your prior level of education at entry to Big Bend
Community College?
Select the number that BEST applies to you and check that box.
11— Less than high school graduation.
12— GED.
13— High school graduate.
14— Some post-high school, no degree or certificates.
15— Certificate (less than two years).
16— Associate Degree.
17— Bachelor's Degree or above.
83— Tech Prep.
90— Other.
What is your family status?
Select the number that BEST applies to you and check that box.
11— A single parent with children or other dependents in your care.
12— A couple with children or other dependents in your care.
13— Without children or other dependents in your care.
90— Other.
Last College Attended City State Year Graduated
Yes No
Do you have a GED certificate?
Yes No
If at BBCC, what year____________
Last High School Attended City State Year Graduated
Yes No
Are you a U.S. Citizen?
Yes No
How long have you resided in Washington State? Years Months
Were you financially independent from your parent or legal guardian for the previous
calendar year? Yes No
If no, how long has your parent or legal guardian resided in Washington State?
Years ________ Months ___________
Are you active duty military, spouse, or dependent child of same? Yes No
If yes, when was the active duty military person first stationed in Washington?
Mo. ________ Day _____________ Yr. ________________
Student ID Number
Are you a veteran?
Yes No
Commitment to Diversity
Big Bend Community College offers a variety of academic, financial, cultural, and personal support
services to interested students. We are commited to enrolling a diverse student body.
Has either of your parents/guardians received a bachelor's degree (4 year degree)?
Yes No
White/Caucasian (800)
Alaskan Native or
Native American (597)
African American (870)
Chinese (605)
Vietnamese (619)
Japanese (611)
Korean (612)
Other Asian or Pacific Islander (621)
Filipino (608)
Other Race (specify) (622)
_________________
Hispanic (717)
Mexican, Mexican-American (722)
Other Spanish/Latino (for exam-
ple: El Salvadorian, Guatemalan,
etc.)
_____________________