Please Note -- All Non-Credit courses must be paid for at time of registration
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 check fees, court filing costs and reasonable attorneys fees, which will add significant costs to my account balance.
Non-Credit Course Refund Policy -- Students must withdraw in writing at least three (3) days prior to the first day of class to receive a full refund of tuition and
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.
Student Signature: __________________________________________________________________________________________ DATE: __________________
Department Chair Signature (For ESOL Students Only): __________________________________________________________ DATE: __________________
The Community College System of New Hampshire (CCSNH) uses electronic signatures and records in place of traditional ones whenever possible. You will conduct busi-
ness elec-tronically with CCSNH using a computer with a supported operating system and internet browser, sufficient electronic storage capacity, a printer and your official
CCSNH email ac-count. 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, registra-
tion and other activities and accounts you may under-take 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.
FOR OFFICE USE ONLY: Date: _________________________________ Entered By: ____________________________
TERM: ______________________
Revised: 03/20 KMH
CRN # Course #
and Section
Course / Workshop Title Comments Tuition
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
*For compliance purposes, the Community College System of New Hampshire and its Colleges collect 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 colleges use of social security numbers will be limited to legitimate educational purposes. The college will exercise due diligence to protect 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.
(Complete all items. Please print clearly and sign in ink at bottom.)
Nashua Community College
Corporate and Community Education
505 Amherst Street
Nashua, NH 03063
Phone (603) 578-8900 Fax (603) 882-8690
Prior Name(s):_______________________________________________ Personal Email Address: _____________________________
*Social Security #: ________ - ______ - __________ Date of Birth: _____ / _____ / ______
A______________________________ _____________________________________________________________________
Check here if this is a change in address, or phone
Current Address: ______________________________________________________ City ____________________________State_________ Zip: __________
Phone: Home ( ) _________________________ Work ( ) ________________________ Cell ( ) ______________________
Employer Name: ______________________________________________________ Employer Contact: __________________________________________
Employer Address: ____________________________________________________ City ____________________________ State ________ Zip ___________
Employer Contact Email Address: _________________________________________
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