One College Drive
Calais, ME 04619
207-454-1012
Continuing Education,
Community Service, &
Non-Degree Seeking
Instate: 800-210-6932
Fax: 207-454-1092
CED – Form Non Matriculated
Registration Revised: May 7, 2020; mda Page 1 of 2
Non-Matriculated Registration
Submit completed form to Elisa LaPointe, Enrollment Services Representative, at elapointe@wccc.me.edu.
Last Name: ___________________________________ First Name: __________________________________ M.I.: _____________
Birth/Other Name: ___________________________________ Email address: ____________________________________________
Mailing Address: _______________________________________ City: ______________________ State: _________ Zip: ________
County: ___________________ Phone Number: ______________________ Mobile Phone Number: __________________________
Cell phone carrier: US Cellular Verizon AT & T Tracfone
Other __________
Social Security / Social Insurance Number: __________________________________
Gender*: □ Female □ Male Birth Date: _______________________________________________
Minor Release Form Required For Students Under 18 Years Of Age
Ethnic Group* (Choose One): □ Not Hispanic/Latino □ Hispanic/Latino
Race*: □ American Indian Or Alaska Native □ Asian
(Choose all □ Black Or African American □ White
that apply) □ Native Hawaiian Or Other Pacific Islander
*Optional-This Information Is Used For Reporting Purposes Only
Your Reason For Enrolling □ Degree Or Certificate □ Personal Enrichment
□ Transfer To Another College □ Skills For Employment □ Other
I Have Been A Resident Of Maine Since _______________________ (For Non-Educational Purposes)
Are You A U.S. Citizen? □ Yes □ No Proof Of Maine/US Residency Required To Qualify For In-State Tuition
Registration Year __________ Term □ Fall □ Spring □ Summer
COURSE CODE
NUMBER & SECTION
YOUR SIGNATURE INDICATES YOU HAVE READ AND UNDERSTAND THE CONDITIONS STATED ON THE BACK OF THIS FORM.
Student Signature: _______________________________________________________________________Date:________________
