Please Note -- You must fulfill your financial obligation two (2) weeks before the beginning of the semester or you may be in jeopardy of be ing deregistered
from your classes.
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 turned 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 fees, court filing costs and reasonable attorneys fees, which will add significant costs to my account balance.
Credit Course Refund Policy -- Students who officially withdraw from NCC or an individual course by the end of the fourteenth (14th) calendar day of the
semester will receive a 100% refund of tuition, less non-refundable fees. Students in classes that meet in a format shorter than the traditional semester (15-16 weeks) will
have seven (7) calendar days from the designated start of the alternative semester to withdraw for a full refund. If the seventh (7th) or fourteenth (14th) calendar day falls
on a weekend or holiday, the drop refund date will be the first business day following the weekend or holiday. Exception: students in courses that meet for two (2) weeks or
fewer must drop by the end of the first (1st) day of the class in order to get a 100% refund.
Registrations will NOT be processed if you have an outstanding obligation to NCC. Upon registration, you are enrolled unless otherwise notified. No confirmation will be
mailed. Classes are subject to change. Students need to check the NCC website ( under the Student Information System (SIS) for their classroom
location(s), schedule, grades, financial aid information, student email account, etc.
Students can register or drop courses without an advisor’s signature but are responsible for taking courses within their program of study and meet graduation requirement.
Student Signature: ___________________________________________ DATE: _______ Advisor Signature: ________________________________ Date: ________
Parental / Guardian Signature: _________________________________ DATE: _______ (For students under the age of 18 only)
Date: _________________________________
Entered By: ____________________________
TERM: ______________________
Federal Governmental Statistical Information (Optional):
Sex: ___Female ___ Male US Citizen: ___Yes ___No
Ethnic Background: Are you Hispanic or Latino: ____ Yes ____ No
Select one or more races: ____ American Indian / Alaskan _____Asian ____ Black or African American ____ Native Hawaiian / Pacific Islander ____ White
CRN # Course #
and Section
Course / Workshop Title Comments Tuition
(Complete all items. Please print clearly and sign in ink at bottom.)
Previous Address: _____________________________________________________City_____________________________ State ________ Zip ____________
Phone: Home ( ) _______________________ Cell ( ) ______________________ Personal Email __________________________________
Current Address: ______________________________________________________City_____________________________ State ________ Zip ____________
Check here if this is a change in address, or phone.
*Federal law requires that Nashua Community College (NCC) collect names and corresponding social security numbers for all student attending the college. The college is required by the Internal Revenue Code to
produce a 109-T tax form (26 U.S.C.A. Section 6050 of Federal Register, Vol 67, No. 2244, page 777686 (ii)) which requires the college to report the names and social security numbers of all students taking credit
bearing courses. Please note, however, that the college will ensure the security of the students social security number and will not disclose it to anyone outside the college, except as authorized by federal or state laws or
applicable policies.
Nashua Community College
505 Amherst Street
Nashua, NH 03063
Phone (603) 578-8900 Fax (603) 882-8690
Prior Name(s):_______________________________________________ Major: ____________________________________________
*Social Security #: ________ - ______ - __________ Date of Birth: _____ / _____ / ______
A______________________________ _____________________________________________________________________
I have met any prerequisite and corequisite that may be required for any of the above courses.
The Community College System of New Hampshire (CCSNH) uses electronic signatures and records in place of traditional ones whenever possible. You will conduct business electronically with CCSNH using a
computer with a supported operating system and internet browser, sufficient electronic storage capacity, a printer and your official CCSNH email account. By logging into CCSNH systems, including but not
limited to Banner SIS and Canvas, you are opting to conduct electronic transactions with the Community College System and consenting to receive written notices electronically, including those involving
financial obligations, and you are acknowledging that CCSNH can use electronic mechanisms alone to convey critical information related to your admission, financial aid, payment plan, student account,
transcript information, registration and other activities and accounts you may undertake or have as a student at CCSNH. You have a right to request a paper copy of an electronic record. You may withdraw your
consent at any time by contacting Student Services. If you decide to withdraw your consent, however, you may be prevented from registering for classes.
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