MARTIN COMMUNITY COLLEGE
Continuing Education Division Registration Form
Course Title: ______________________________________________________________________________
GENERAL INFORMATION
Student Social Security Number Birthdate Sex: Male Female
Name ___________________________________________________________________________________
Last First Middle/Maiden
Address City State Zip_____________
County Residence _____________________________ Home Phone (________) ___________________________
Cell Phone (________) _________________________ Work Phone (_______) ____________________________
E-mail Address _____________________________________________________________________________
Ethnicity: Hispanic/Latino Not Hispanic/Latino
Race: (check one or more)
American/Alaska Native Asian Black or African American Hawaiian/Pacific Islander White
Employment Status: Full-time Part-time Unemployed (seeking) Unemployed (not seeking) Retired
Employer _________________________________________________________________________________
Occupation ________________________________________________________________________________
EDUCATIONAL INFORMATION
Highest educational level completed: (check one) 1 2 3 4 5 6 7 8 9 10 11 12
HSE Diploma (formerly known as GED) Adult High School Diploma College Vocational Diploma Associate Degree
Bachelor’s Degree Master’s Degree or Higher
STUDENT TYPE
Senior Citizen Fire & Rescue/EMS/Law Enforcement Dual Enrollment Employee Inmate
Is your tuition being paid by an agency/organization? If yes, please specify:
(Copy of authorization to pay must be on file or attached to registration form)
How did you hear about this course? Please check only one.
Flyer MCC Website School Mailing Advertisement Other:
List other programs you would like to receive information on:
Student Signature _____________________________________________________ Date _____/_____/______
CONSUMER INFORMATION
Consumer information is available to all students and prospective students in keeping with the requirements established by the Higher Education Opportunity Act. General information
about the College including financial assistance; annual campus crime report (http://www.martincc.edu/news/Crime/Annual_Security_Report.pdf) retention, transfer and completion
rates; and FERPA rights are available. This information may be accessed on the College’s website under the Campus Information Link. Paper copies are available upon request in the
Registration Center in Building 1 or the Continuing Education Office in Building 2 during daytime business hours. Paper copies are available from the switchboard in Building 1 during
evening hours.
08/17/2015
Photography & Quote Release: I hereby authorize Martin Community College to use my image and/or
quotes for any use the College deems appropriate in the promotion and marketing of MCC. I fully discharge
MCC from any and all claims, monetary or otherwise, arising out of the use of my image or quote.
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CONTINUING EDUCATION
PRE-REGISTRATION PROCESS
REGISTRATION INFORMATION
You may register for Continuing Education classes on a first-come, first-served basis. Please complete registration
form and payment at least 72 hours (3 days) prior to beginning date of your class. If you wait, your class may
either be full or canceled because of a low number of registrations. Late registration will be held at the first class
meeting if space is available. Third Party Authorizations must be received at least 72 hours (3 days) prior to the
start of class. Should the College be closed 72 hours prior to the start of class, registration will be taken the first
day the College is reopened. Registration forms are available in the Continuing Education Division and online at
www.martincc.edu under the Continuing Education Page. Payment can be made with cash or check only! Make
all checks payable to MCC.
HOW TO REGISTER
IN-PERSON (WALK-IN) REGISTRATION
Monday through Friday, 8:30 AM 4:00 PM, except holidays
Building 2, Room 35 (Williamston Campus)
OR
MAIL REGISTRATION FORM & PAYMENT TO:
Martin Community College
Continuing Education Department
1161 Kehukee Park Road
Williamston, NC 27892
WHO MAY REGISTER
Any adult 18 years of age or older (and out of high school) may register for a Continuing Education course.
Individuals 16 to 17 years old may register upon recommendation of the chief administrative school officer and
parent/guardian. Martin Community College reserves the right to change schedules at any time and to add or
withdraw courses.
REGISTRATION FEES
A registration fee is charged for most Continuing Education courses. Tuition rates for North Carolina Community
Colleges are established by the State Board as set by the NC Legislature for continuing education students per
class for North Carolina residents and out-of-state students (per NCCCS Administrative Code).
1 – 24 hours ………….. $ 70.00
25 – 50 hours ………… $125.00
51 + hours ……………. $180.00
(Tuition rates subject to change)
REFUND POLICY
A 100% refund shall be made if the student withdraws prior to the first class meeting. A 75% refund shall be made if the
student withdraws from class prior to the official 10% point of the class. Request for refunds must be made by completing
a Continuing Education course withdrawal form prior to the 10% point of the class. Forms are available in the
Continuing Education Office. For classes canceled by the College, a full refund shall be made. You do not have to
request a refund in these cases. No refunds shall be made after the 10% point of the class. No refunds are granted for self-
supporting courses once the class has started.
Cancellation of Courses: Continuing Education non-credit classes are subject to cancellation if enrollment is
insufficient. Registered students will be notified if classes are canceled.
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