Fillable Course Registration Student Information Submit Completed form through (Modesto Junior College)

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Course Registration Student Information Submit Completed form through (Modesto Junior College)

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Course Registration
Submit Completed form through your student email to MJCESeForms@mjc.edu. Forms will NOT
be accepted prior to your registration date and time.
Today’s Date:
Student Information
First Name: Middle Initial: Last Name:
Student ID: w Birthdate: Phone Number:
Course Information
Term/Year: Fall Spring Summer
Student Signature: Date:
I acknowledge that I have been added to a waitlist. If I am granted access to the course by the instructor, I am aware
that I need to return to Enrollment Services with the necessary documents and the access code. (initials)
OFFICE USE ONLY
Registered by: Date: ID Veried
Pre-Requisite/Co-Requisite Time Conict H.S. Max 10% MXW
3rd Enrollment Student Petition Grade Improvement STAC
Comments:
03/2020_SJB
MJC Enrollment Services • Phone (209) 575-6853
East 435 College Avenue, Student Services Bldg. 1st Floor • WEST 2201 Blue Gum Avenue, Yosemite Hall 1st Floor
Section # Course Name & Number Access Code Refund Date Census Date
1234 MBUSAD - 201 1234 08/27/2020 Oce Use Only
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Course Registration Student Information Submit Completed form through (Modesto Junior College)

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Completed 4 September 2020

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