Date Residency Tuition Assistance
______/______/20______
Term:
Fall Spring Summer
I currently reside:
In the state of Texas
Not in the state of Texas
State:________ County:___________________
DARS TPEG
Hazelwood Exempt
WIOA
TAA
* Social Security Number is required if you are applying for financial aid but is not required for admission. Providing a Social Security Number (SSN) will, however, speed up the processing of your application
since we will not need to manually match your application with other materials such as transcripts and test scores. Supplying a SSN also ensures that you will be able to claim the Hope Tax Credit if you are
eligible on your federal tax return. Lone Star College uses the SSN for compliance with federal and state reporting requirements and has a strong commitment to ensuring the privacy and confidentiality of student
records and will not disclose your Social Security Number without your consent for any purpose except as allowed by law.
Career & Technical Education / Corporate College
REGISTRATION FORM
Last Name: First Name: Middle Name: Student ID or Soc. Sec. No.*
Previous Last Name: Date of Birth: Phone No.
Home: Cell:
Address:
Address Change?
Yes No
Mailing Address (if different)
City: State: Zip:
Emergency Contact Name: Relationship: Phone No:
Demographic Questionnaire
Gender: M F
The following questions are used by the state to help provide support for our programs.
Although not required, your cooperation is appreciated.
Race (Check all that apply)
American Indian/Alaskan Native
Asian
Hispanic or Latino
Not Hispanic or Latino
Black/African American
Native Hawaiian/Pacific Islander
White
Additional Information
Academically disadvantaged Limited English
Economically disadvantaged Displaced Homemaker
Disabled: Single Parent
Type of Disability ______________________________________________
How did you hear about us?
Received a schedule in the mail
Picked up a schedule from a business location
Business______________________________________
LoneStar.edu
Other_________________________________________
What is your primary goal?
• Personal Enrichment
Leisure Learning Academy for Lifelong Learning (ALL) Member
Professional Development
Workforce Certificate, Which certificate? ______________________________________________
Other ____________________________________________________________________________
Course Selection
Payment is due at the time of registration.
_________ (please initial) I understand that if I wish to drop a class and
receive a full refund, I must drop the class three business
days before the class is scheduled to begin.
Make all checks payable to Lone Star College System.
A $21 infrastructure fee is charged per semester.
Class #
Ex: 55555
Catalog #
ITSCC 2100103
Course Fee
$180
Course Title
Introduction to Computers
Campus
LSC-CyFair
Start Date
09/03/19
Visit LoneStar.edu •
Action/EEO College • For more information on bacterial meningitis please go to
Mail or deliver this form in person.
Online Registration is available: LoneStar.edu/CE-Registration
www.Tdh.state.tx.us
Total Fee
Method of Payment
Entered by
Date
Receipt #
Student Signature:
Charge to My:
AmEx Discover
Master Card Visa
Card No: Expiration Date: CID number on front or back:
Name on Card: Authorized Signature: Billing Address:
Bottom portion to be destroyed.
Student Registration Information
City: State: Zip:
Email Address:
