_________________________________________ _________________________________
TVCC Student ID -or- Social Security Number* Date of Birth
_________________________________________ __________________________________________ _________
Last Name First Name M.I.
_________________________________________ ____________________ _________ _________
Permanent Physical Address City State Zip
_________________________________________ ____________________ _________ _________
Mailing Address (if di erent than above) City State Zip
___________________________ ___________________________ ___________________________
Home Phone Cell Phone Work Phone
_________________________________________
E-mail Address (Required)
______________________________________ _____________ ______________________________________ _____________
Student Signature Date Advisor Signature Date
Student Consumer Information: Treasure Valley Community College complies with the Student-Right-to-Know Act, Campus Security/Clery Act of 1990 and Equity in Athletics Disclosure Act. For information or complete
reports concerning graduation, completion, and transfer-out rates, the annual campus security report, athletic program participation rates and nancial support data, and the college’s policy concerning drug and alcohol
abuse prevention, please visit http://www.tvcc.cc/about_tvcc/index.cfm.
*Providing your social security number is
voluntary. If you provide it, the college will
use your social security number for keeping
records, doing research, reporting, extend-
ing credit, and collecting debts. The college
will not use your number to make any
decision directly a ecting you or any other
person. Your social security number will
not be given to the general public. If you
choose not to provide your social security
number, you will not be denied any rights
as a student. Providing your SSN means that
you consent to the use of your number in
the manner described.
www.tvcc.cc · 650 College Boulevard, Ontario, OR 97914 · (541) 881- 8822
Treasure Valley Community College is an equal opportunity educator and employer.
Center for Business, Workforce & Community Learning (CBWCL)
Registration Form
Company PO# __________________ (must be presented) Company _______________________________________________
Agency Voucher __________________ (must be presented) Agency _______________________________________________
Gender:
__Male __Female
U.S. Veteran?
__Yes __No
Citizenship:
__U.S. Citizen/ Oregon
__U.S. Citizen/NOT Oregon
__Not a U.S. Citizen
High School completed:
__Still in high school
__High School Diploma
__GED
__CIM
__Pro ciency exam
__Home school
__ High School Diploma from a Community College
__External diploma program
Marital Status:
__Divorced / Separated
__Married
__Single
__Widowed
Primary reason for attending TVCC:
__Take transferrable classes
__Learn skills to get a job
__Improve job skills
__Explore Career / Academics
__Take classes to earn HS diploma / GED
__Improve reading/writing/math skills
__Learn English Language
__Personal Interests / enrichment
__Other: ________________________________
Select your ethnicity:
__Hispanic / Latino
__Not Hispanic / Latino
Select your preferred race:
__American Indian / Alaskan Native
__Black / African American
__Native Hawaiian / Paci c Islander
__Asian
__White
__Other
Highest degree level you have completed:
__None
__Other(short term training)
__1-Year Certi cate
__2-Year Associate Degree
__Bachelor's Degree
__Master's Degree
__Ph.D/Professional Degree
CLASSES ADDED:
Course # Section Course Title Credits Time Days Instructor Cost
CLASSES DROPPED: Subject to CBWCL Policy.
Course # Section Course Title Credits Time Days Instructor Cost
QUARTER: _____ SUMMER _____ FALL _____ WINTER _____ SPRING
Persons having questions about
or requests for special needs and
accommodations should contact the
Disabilities Services Coordinator at
Treasure Valley Community College,
650 College Blvd., Ontario, OR 97914.
Telephone (541) 881-5812.
Revised 12/12/11
By signing this registration form, I agree to pay all tuition and fees applicable to the courses registered for above. Charges are subject to change at any time before the start of an academic
quarter. The current charges can be found in the most recent printed class schedules, and on the college website. Whether or not any court action is involved, all expenses, fees, attorney fees and
actual collection costs incurred by TVCC in an attempt to collect funds due shall become a part of the unpaid principle balance and payable upon demand. When expenses, fees and collection costs
become a part of the unpaid principle balance, I understand my debt to TVCC may double. In the event legal action is instituted for the collection of this debt, the prevailing party shall be entitled
to recover, at trial and on appeal, reasonable attorney fees and costs.
