Great Bay Community College
Business & Training Center
320 Corporate Drive, Portsmouth, NH 03801 P: (603) 427-7610 F: (603) 334-6308
www.greatbay.edu/btc
Non-Credit Registration Form
(Complete all items. Please print clearly and sign in ink.)
STUDENT ID
LAST 4 DIGITS ONLY OF SOCIAL SECURITY NUMBER*
FIRST NAME MIDDLE NAME LAST NAME
PRIOR NAME(S) (If applicable) DATE OF BIRTH (mm/dd/yy)
HOME ADDRESS APT# CITY/TOWN STATE ZIP CODE
( ) ( ) ( )
HOME PHONE WORK PHONE CELL PHONE
EMPLOYER NAME/ADDRESS (If applicable)
OCCUPATION/JOB TITLE
COURSE REGISTRATION
Course Title / Description
STUDENT SIGNATURE
DATE
Revised July 29, 2020
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 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.
Tuition Refund Policy (Non-Credit Courses): All Students registered for non-credit workshops, tests, professional training, or seminars must withdraw in writing at least three business days prior to the first
session. Payments by cash or check will receive a full refund of tuition and fees. Exception: non-credit workshops, tests, professional training, or seminars registered online with a credit/debit card incur a non-
refundable 7.0% transaction fee and a non-refundable $1.99 administration fee. Refunds take approximately four to six weeks to be processed.
*For compliance purposes, the Community College System of New Hampshire and its Colleges collects 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
ensure 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.
Registrations will NOT be processed if you have an outstanding obligation to GBCC. Upon registration, you are enrolled unless otherwise notified. Classes are subject
to change.
PERSONAL EMAIL ADDRESS (Please provide incase your class is cancelled or changed.)
CHECK HERE IF THERE IS A CHANGE IN NAME, ADDRESS, OR PHONE.
BLACK/AFRICAN AMERICAN
NATIVE HAWAIIAN/PACIFIC ISLANDER
RACE:
AMERICAN INDIAN/ALASKAN NATIVE
ASIAN
HISPANIC/LATINO
VET USING GI BILL
DEPENDENT USING GI BILL
DISABLED VET USING GI BILL
MALE
FEDERAL GOVERNMENT STATISTICAL INFORMATION: (Optional)
FOR OFFICE USE
Fall Spring Summer
Registered by
Phone Registration
_____
Date
click to sign
signature
click to edit
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