Term: Summer _____Fall_____ Winter _____ Spring/Winterim _____
Student Name: ____________________________________________ Student ID: _________________________________________
Major: _______________________________ Date of Birth: ______________ Phone: ______________________________________
ADD
CRN Course # Course Title
I understand that by registering for courses at LRCC, I am financially obligated for ALL costs related to the registered course(s). Upon
a drop or withdrawal, I understand 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 understand that I will be responsible for the costs of the outside collection agency, any legal fees, and any
bounced check fees under RSA 6:11, which will add significant costs to my account.
I understand that if I drop a course by the end of 14th calendar day of the semester, the course will not appear on my transcript and I
will receive a 100 % refund of tuition, less non-refundable fees. If the class meets in a format shorter than the traditional semester, I
will have 7 calendar days from the designated start of the alternative semester to withdraw for a full refund. If I drop a course after
the 14th calendar day, but during the first 60% of the semester, the course will be recorded as a “W” on my transcript and I will not
receive a refund. Exception: students in courses that meet for two weeks or fewer must drop by the end of the first day of the class in
order to get a 100% refund. Students registered for workshops must withdraw in writing at least three (3) business days prior to the
first workshop session in order to receive a full refund of tuition and fees.
Student Signature Date Advisor Signature Date
For Office Use Only: Date Received: ____________ Received by: ___________ Processed in Banner: _____________
Rev 04/27/2020
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Office of the Registrar
379 Belmont Road, Laconia, NH 03246
Phone: (603) 524-3207 Fax: (603) 524-8084
Email: lrccregistrar@ccsnh.edu
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