Fillable MCC Credit- Free Registration Form

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MCC Credit- Free Registration Form

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File type: PDF

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Continuing Education
Credit-Free Course Registration
Complete this form. One form per person. You may register for credit-free courses by:
MAIL: Mail form and payment to Continuing Education Registration, MS #13,
Manchester Community College, P.O. Box 1046, Manchester, CT 06045-1046.
IN-PERSON: Go to the Registrar’s Office, SSC L157and pay at the Bursar’s Office, SSC
L165. Cash, check, money order, American Express, Discover Card, MasterCard or
Visa accepted. Please use night drop box after hours.
FAX: Complete a registration form with American Express, Discover Card, MasterCard
or Visa. Fax 860-512-3221; call 860-512-3232 to confirm that your fax was received.
PHONE: Call 860-512-3232 between 8:30 AM and 4:30 PM, Monday-Friday, using
American Express, Discover Card, MasterCard or Visa. Please leave a detailed voice
message if staff is unavailable.
ONLINE: Go to www.manchestercc.edu/ce. Click Web/Flexible Registration.
Please note: No written confirmations are mailed. Registrants will be contacted by
MCC only if a course is full, cancels, or if classrooms, meeting times or dates change.
APPLICANT INFORMATION
Include both a day and evening phone numbers in case we need to inform you of a scheduling change or cancellation.
First Name MI Last Name Banner ID (if known)
Previous Name (if any) Email
Street Address
Apt. #
City State Zip
Home Phone Work Phone Cell Phone
Date of Birth
Gender
n
Male
n
Female
Today’s Date
LIST COURSES:
CRN COURSE TITLE START DATE TIME ROOM FEE
REFUNDS: Refunds are issued only for credit-free courses that MCC cancels, or if a written request is received no later
than the end of the last business day prior to the first day of the course. For MCC information on credit-free course
TOTAL FEES:
refunds, go to www.manchestercc.edu/refund.
METHOD OF PAYMENT
Please indicate method of payment below. Make checks payable to MCC.
Payment Information (please check only one):
n
American Express
n
Discover
n
MasterCard
n
Visa
n
Money Order
n
Cash (no cash by mail)
n
Check # _____________
Credit Card Number CVC Code Expiration Date
Cardholder Signature Date Signed
Cardholder Name (print)
Relationship to Student
Cardholder Address
Cardholder Phone
January 2019/PR
OFFICE USE ONLY
Regis. _________________ Special: _________________ Receipt #: ___________________ Date: __________________
$0.00
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MCC Credit- Free Registration Form

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Completed 25 July 2020

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