Enrollment Request
LFCC Admissions / Enrollment Services Office
173 Skirmisher Ln · Middletown, VA 22645
Telephone: 540-868-7110 Email: admissions@lfcc.edu Fax: 540-868-7005
For office use only
Electronic signature verified by: _________________ Processed by: _____________ Date __________________
Revised 10/17/2019 GOLDENROD
Semester: □ Fall □ Spring □ Summer Year: 20____
Student ID# Date of Birth Phone
Name
Last First Middle
ADD
Class # Subject Course # Section Course Title
Session
(15, 12, 10, 8, 5 week)
Credits
12345 MTH 163 1H0M Precalculus I (example) 15 3
DROP
Class # Subject Course # Section Course Title
Session
(15, 12, 10, 8, 5 week)
Credits
Student’s Signature: Date:
I voluntarily consent to the use of an electronic record of my LFCC student file. I acknowledge that, by logging into the MYLFCC system with my unique credentials and e-
mailing from my @email.vccs.edu account to provide LFCC with this data, I have given my electronic signature which has the same legal and binding effect as a "wet" or
handwritten signature.
OVERRIDES
□ Foreign applicant hold □ Class/Instructor permission □ Other
□ Credit Load - Permission required to register for more than 18 credits, not including SDV 100. If the student’s cumulative GPA is
below 3.000, the advisor must provide written justification for the override.
GPA: □ Approved □ Not Approved
Faculty/Advisor/Counselor’s Signature: Date:
□ Pre-requisite - Justification:
□ Class limit □ Time conflict □ Reinstatement approval □ Other exception
(suspension/dismissal)
Academic Dean /Designee’s Signature: Date:
