Student ID:
EARLY COLLEGE REGISTRATION FORM
31 College Dr, Concord, NH 03301
Mark Bograd, Coordinator of High School Outreach (603) 230-4029 - mbograd@ccsnh.edu
Registrar’s Office (603) 230-4014 – Fax – (603) 230-9314 – nhtiregistrar@ccsnh.edu
Semester: Fall Spring Summer Year:
Last Name: First Name: Middle Name:
Mailing Address: City: State: Zip:
Home Phone: Cell Phone:
E-Mail Address: *Social Security #:
*For compliance purposes, the Community College System of New Hampshire and its Colleges collect names and social security numbers from all students attending the
college. For example, the Internal Revenue Code requires the college to produce a 1098-T tax form. The college’s use of social security numbers will be limited to
legitimate educational purposes. The college will exercise due diligence to protect the security of the student’s social security number and will not disclose it to anyone
outside the college, except as authorized by federal or state laws or applicable policies.
Federal Governmental Statistical Information (Optional): Sex: F M Date of Birth: / /
Ethnic Background: Hispanic or Latino Not Hispanic or Latino
Select one or more races: American Indian/Alaskan Asian Black or African American Native Hawaiian/Pacific Islander White
Tuition for Early College is $322.50 for a 3 credit course and $430 for a 4 credit course; books and supplies are not included.
Financial Obligation Statement -- I agree that by registering for courses within the Community College System of New Hampshire (CCSNH), I am financially obligated for
ALL costs related to the registered course(s). Upon a drop or withdrawal, I agree that I will be responsible for all charges as noted in the student catalog and handbook. I
further understand that if I do not make payment in full, my account may be reported to the credit bureau and/or turned over to an outside collection agency. I also agree to
pay for the fees of any collection agency, which may be based on a percentage of the debt up to a maximum of 35%, and all additional costs and expenses, including any
protested check fees, court filing costs and reasonable attorney’s fees, which will add significant costs to my account balance.
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HTI Refund Policy -- Students who officially withdraw from NHTI or an individual course by the end of the fourteenth (14th) calendar day of the semester will receive a
100% refund of tuition, less nonrefundable fees. Students in classes that meet in a format shorter than the traditional semester (15- 16 weeks) will have seven (7) calendar
days from the designated start of the alternative semester to withdraw for a full refund, less non-refundable fees. If the seventh (7th) or fourteenth (14th) calendar day falls on
a weekend or holiday, the drop refund date will be the first business day following the weekend or holiday. Exception: students in courses that meet for two weeks or fewer
must drop by the end of the first day of the class in order to receive a 100% refund, less non-refundable fees. [Please note that certain fees are non-refundable. Non-
refundable fees are defined as advance tuition deposits, admission application fees, residence hall room deposits, payment plan fee, orientation fees. All other fees are to be
considered refundable. This includes, but is not limited to academic instruction fees, lab fees, comprehensive student services fees, and the Nursing, Dental, and Diagnostic
Medical Imaging Program clinical surcharges.
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Student Signature Date Parent/guardian signature Date
(Required if student is under 18)
METHOD OF PAYMENT
Credit Card if paying in FULL (please note a 2.75% convenience fee will be charged):
Card Type: Master Card VISA Discover
Name on credit card: _
Acct #: _
Exp Date: Phone:
Billing Address: _
City: St: Zip:
Signature: _
Cash (do not mail)
Check Attached Payable to: NHTI, Concord’s Community College
Payment is due at the time of registration.
Registration will NOT be processed if you have an outstanding obligation to CCSNH.
Upon registration, you are enrolled unless otherwise notified. No confirmation will be
mailed. Classes are subject to change. Students need to check the SIS for their
schedules, classroom location(s), grades, semester charges, student email account, etc.
Revised 03/21
