Registration
for School Year
Name (Last) (First) (MI)
Date of Birth
TRCC Student ID#
@
Address No. & Street City/Town State Zip
New Address
YES NO
CT Legal Resident
YES NO
Male Female
Email Address
( )
Cell Phone
( )
Date of
Registration
High School
Expected Year of High School Graduation
CRN#
SUBJECT
COURSE
NUMBER
CLASS TITLE
CREDITS
PRE-REQUISITE
MET?
YES NO*
YES NO*
YES NO*
YES NO*
COMMENTS:
* IF THE STUDENT HAS NOT MET THE COURSE PRE-REQUISITE, PERMISSION OF THE INSTRUCTOR IS REQUIRED.
__________________________________________________
Instructor Signature
PLEASE COMPLETE AND RETURN THIS FORM TO YOUR GUIDANCE COUNSELOR FOR THEIR APPROVAL.
__________________________________________________
Guidance Counselor Signature
College Career Pathways Office
574 New London Turnpike
Norwich, CT 06360
860-215-9297
Office Use
Date Entered: ____________
Entered By: ______________
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