Refund Policy: To be eligible to request a refund, you must submit a request in writing by the following deadlines:
Certificate Trainings & Professional Education Programs: Before the start of the second (2nd) class).
ESOL, HiSET, and other Lifelong Learning Programs: At least one (1) business day before the first (1st) class.
Center for Workforce Development
Building #4, Room 102
Business Office: Academic Building #3, Room 125
STUDENT INFORMATION (Please print clearly) FY’20_____ Fall Spring Summer
Last Name: ____________________________________ First Name: ________________________________
Address: _________________________________________________________________________________
City: __________________________________________ State: __________ Zip: ____________________
Phone: _______________________________________ Gender: Female Male
Email: ________________________________________ Date of Birth: ______________________________
Demographic Information Educational Information
1. Please select the race(s) you identify as: Do you have:
American Indian or Alaska Native High School Diploma GED/HiSET
Asian Black or African American Currently pursuing GED/HiSET Don’t have
Native Hawaiian or other Pacific Islander Have you attended RCC before? Yes No
White Are you an RCC Degree Candidate? Yes No
3. Are you Hispanic or Latino? Yes No Student is Child Under Age 18 Yes*
4. Are you Cape Verdean? Yes No *Must complete Photo Release/Liability Waiver
4. Country of Citizenship: _________________________
5. If you are not a US citizen, do you have Permanent Resident Status (green card)? Yes No
COURSE REGISTRATION
COURSE CODE
COURSE NAME
DAY
TIME
TUITION
End
CSA
CSA
CSA
CSA
STUDENT ID #:
TOTAL AMOUNT TO BE PAID:
NON-CREDIT REGISTRATION FORM
I hereby register for the above course(s) and assume full responsibility for the accuracy of the information above.
Student’s Signature: ________________________________________ Date: ___________________
Payment Method: □ Credit/Debit Card □ Check □ Money Order
RCC Staff Signature: _______________________________________ Date: ___________________
$
$
$
$
$
20-21