Term: Summer Fall Spring Year: ______ ___
Last First Middle
Permanent Address: _________________________________________________________________________________
Street City State Zip
Home Phone: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ Cell Phone: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
Personal Email Address: ______________________________________________________________________________
State of Residency: ____ ____ If Minnesota, how long? _____ yrs. *Gender: M ____ F ____
U.S. Citizen: ❐Yes ❐No __________ Visa Status (please attach copy of Visa) ❐ *Military Veteran
*SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___ *Date of Birth __________________________________
This form is for individuals not formally admitted to an ATC certificate, diploma or degree program who want to enroll in
undergraduate coursework. Students seeking to enroll in an ATC degree, licensure, or certificate program must formally
apply through the Admissions office and provide official transcripts from all schools attended.
Financial aid is not available for Visiting Students. If students hold a formally admitted status at another MnSCU
institution, they may apply for financial aid through their home school via the MnSCU Consortium Agreement. Students
receiving financial aid from a non-MnSCU institution must supply a written consortium agreement from their home school.
Visiting Student status is valid for one term at a time. Students must re-apply each term. Visiting Students are
responsible for adhering to ATC deadlines, policies, and procedures published in the ATC student handbook. Once
registered for a course, students are responsible for all tuition and fees associated with their registration. Failure to
attend class does not constitute a valid drop, withdrawal, or cause for refund. Students enrolling in courses requiring pre-
requisites must provide the appropriate documentation (e.g., transcript). Students needing documentation from another
MnSCU institution should request a free eTranscript.
To register, drop or withdraw from courses, log into eServices account from ATC website: http://www.anokatech.edu
For more info call Anoka Technical College at 763-576-7740.
I have read and agree to the above information.
Student Signature: _________________________________________________ Date____________________
MAIL OR FAX FORM TO:
Anoka Technical College, ATTN: Records and Registration 1355 W Highway 10, Anoka, MN 55303
Student ID: ____ ____ ____ ____ ____ ____ ____ ____
*ATC uses Social Security Numbers, Date of Birth and Gender for student identification purposes on student records. Providing this information is voluntary. If you do
not supply this information, your application will still be processed. This data is requested for purposes of administration, program evaluation, and consumer data. Your
information may also be used to create summary data about MnSCU programs through data matches with other state agencies.
Non-Degree/Visiting Student Agreement