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Academic Dean
Max Hr. Approval:
Registration
Form
Aravaipa
Maricopa San Tan Signal Peak
Superstition Florence Casa Grande Center
Casa Grande Corporate Center
Student ID Semester of Registration: Year 20
Number / SSN Fall Spring Summer
*Please note that your social security number is required during your initial admissions process.
All students receiving Financial Aid must provide a valid Social Security Number, declare an area of interest and provide Official Transcripts from previous institutions attended. In addition,
any student that is in need of a 1098-T for Federal Tax purposes must also provide a valid Social Security Number at the time of admissions.
Legal Name: Last: First: Middle Initial:
Previous Name (maiden):
Mailing Address: Street/P.O. Box: Apt.:
City: State: Zip:
4 Telephone: Home:( _)
Cell: ( _) Email:
Emergency Contact: Name: Relationship: Phone:( _)
Date of Birth: / /
Month
Day Year
Student Type:
New/First Time Continuing *Dual Enrollment/Early Transfer Non Degree Seeking *GED/HSE
*Minor/Under 18 (Not participating in Dual Enrollment/Early College) Re-entry, returning after one or more semesters
*Student types require additional paperwork each semester.
Area of Interest:
Associate of Arts Degree (AA)
Associate of Science Degree (AS)
Associate of Arts Degree–Elementary Education (AAEE)
Associate of Applied Science Degree (AAS)
Associate of Business Degree (ABUS) Certificate
Associate of General Studies Degree (AGS)
I have reviewed my area of interest with my Academic Advisor and understand that all registered classes must apply towards degree/certificate completion for
financial aid eligibility.
Tuition and fees are due at the time of registration. Failure to make payment and/or payment arrangements will results in the loss of registration.
Refund Policy: Regular Semester Length Classes: 100% of tuition/fees will be refunded if the official withdrawal is completed prior to the class start. 90% of tuition/fees will be
refunded if the official withdrawal is completed during the official add/drop period. There are NO refunds issued for withdrawals completed after the official add/drop period. Short
Term Classes: 100% of tuition/fees will be refunded if the official withdrawal is completed prior to the class start. There are NO refunds for short term classes after the start of the
class.
Course Number
(ex. MAT082)
Course Title
(ex. Basic Arithmetic)
Campus Cred Days Time
(if required)
By signing below, I certify that the information given is complete to the best of my knowledge. I understand that submission of false
information is grounds for denial of admission or immediate suspension if enrolled. As a student of Central Arizona College, I agree to abide
by the Student Code of Conduct of the college regarding conduct and other obligations. In addition, I understand that Central Arizona College
institutional student business by electronic delivery. This includes, but not limited to admissions, registration and billings, Form 1098-T and
direct deposits. You may withdraw your consent of electronic delivery by writing Central Arizona College, Attn: Accounts Receivable, 8470 N.
Overfield Road, Coolidge, AZ 85128.
Student Signature: Date:
Revised Oct.2018
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