Community College Registrar’s Office, 170 Elm Street, Enfield, CT 06082
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Semester: FALL 20 ____ SPRING 20 ____ SUMMER 20 _____ WINTER 20____
Student/Banner ID # ____________________
Last Name:__________________________ First Name:_________________________ Middle Name:_____________
If any of your contact information has changed, please complete the following:
Mailing Address ____________________________________________________ Home Phone ___________________
Number and Street
__________________________________________________________________ Cell Phone ____________________
City, State, Zip
Email Address ______________________________________________________ Work Phone ___________________
Advisor’s Signature___________________________________________________ Date _____________________
Payment Information: Prior to the Tuition Due Date all fees are due at the time of registration including Application, Student
Activity, College Service, Lab and Installment Plan Fees (if applicable). As of the Tuition Due Date, full payment of tuition and fees is
due at the time of registration. Application, Student Activity and College Services fees are NON-REFUNDABLE. Registering for
classes obligates you to pay for the courses you have registered for. The liability for the tuition and fees is incurred at the time of
registration. By registering for classes, you are now responsible for payment. Failure to pay these fees at the time of registration
MAY result in the cancellation of your registration. Students are responsible for payment of all non-refundable fees, even if the
student withdraws or is removed from the class for non-payment. Please see our refund policy at
or you may obtain a Student Refund Policy brochure at the Cashier’s Office.
To the best of my knowledge, the information on this registration form is complete and accurate. I assume responsibility for
knowing and following course prerequisites, co-requisites, program requirements, and payment obligations.
Student Signature ________________________________________________ Date _____________________
Notice of Non-discrimination: Asnuntuck Community College does not discriminate on the basis of race, color, religious creed, age, sex, national origin, marital status,
ancestry, present or past history of mental disorder, learning disability or physical disability, sexual orientation, gender identity and expression or genetic information
in its programs and activities. In addition, the College does not discriminate in employment on the basis of veteran status or criminal record. The following individuals
have been designated to handle inquiries regarding the non-discrimination policies: Yhara Zelinka, Title IX Coordinator,
(860) 253-3092 and
Deborah Kosior, 504/ADA Coordinator, (860) 253-3005, Asnuntuck Community College, 170 Elm Street, Enfield, CT
06082.Políticas Antidiscriminatorias: Asnuntuck Community College no discrimina por razones de raza, color, creencias religiosas, edad, género, nacionalidad, estado
civil, ascendencia, historia presente o pasada de discapacidad mental o física, problemas de aprendizaje, orientación sexual, Identidad y expresión de género, o
información genética, en sus programas o actividades. Adicionalmente Asnuntuck no discrimina individuos por razones pertinentes a la categoría de veteranos o
historia criminal. Las siguientes personas han sido designadas para resolver cualquier inquietud pertinente a las políticas antidiscriminatorias: Yhara Zelinka, Title IX
Coordinator, (860) 253-3092 and Deborah Kosior, 504/ADA Coordinator, (860) 253-3005, Asnuntuck
Community College, 170 Elm Street, Enfield, CT 06082. Updated March 2020