Fillable REGISTRATION FORM Signatures required as indicated below. Use (Columbia Basin College)

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REGISTRATION FORM Signatures required as indicated below. Use (Columbia Basin College)

On average this form takes 45 minutes to complete

The REGISTRATION FORM Signatures required as indicated below. Use (Columbia Basin College) form is 2 pages long and contains:

  • 2 signatures
  • 30 check-boxes
  • 156 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Columbia Basin College

BROWSE COLUMBIA BASIN COLLEGE FORMS

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REGISTRATION FORM
Use this form to complete a schedule change, late enrollment, audit, class overload and over 18 credit requests.
Signatures required as indicated below.
TO BE COMPLETED BY THE STUDENT:
Quarter: Summer Fall Winter Spring Year: SID #:
Last Name: First Name: MI: Male Female
Cell Phone #: Other Phone #: Birth Date:
Address: City: State: Zip:
ITEM # COURSE ID
# OF
CREDITS
PUT AN “X” IN THE
APPROPRIATE BOX
INSTRUCTOR APPROVAL (INITIAL AND DATE)
INSTRUCTOR SIGNATURE
ADD DROP AUDIT LATE ENROLLMENT OVERLOAD CAPACITY DATE
Over 18 Credits Advisor Signature: Date:
Financial Aid Disclaimer: I wish to make a change to my schedule as noted above and understand that making this change may aect my financial aid in adverse ways (ie: loss of future
financial aid, owe money back to the College, etc). I further understand that I should speak with a Hawk Center Specialist prior to processing.
LIMITATION OF LIABILITY: The College’s total liability for claims arising from a contractual relationship with the student in any way related to classes of programs shall be limited to tuition
and expenses paid by the student to the college for those classes or programs. In no event shall the college be liable for any special indirect, incidental, or consequential damages, including
buy not limited to, loss of earnings or profits.
Student Signature: Date:
Processor Signature: Date:
For Ocial Use Only
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the basis of race, color, creed, religion, national or ethnic ori-
gin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or ser-
vice animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individ-
uals with disabilities are encouraged to participate in all college sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
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Select only one best response for the following questions.
How long do you plan to attend Columbia Basin College?
11 One quarter
12 Two quarters
13 One year
14 Up to two years, no degree planned
15 Long enough to complete a degree
16 Don’t know
90 Other
What is your current work status while attending college?
11 Full-time homemaker
12 Full-time employment (including self-employed and military)
13 Part-time o-campus
14 Part-time on-campus
15 Not employed, but seeking employment
16 Not employed, not seeking employment
90 Other
What is your prior level of education at entry to Columbia Basin College?
11 Less than high school graduation
12 GED
13 High school graduate
14 Some post high school, but no degree or certificate
15 Certificate (less than two years)
16 Associate's degree
17 Bachelor’s degree or above
90 Other
What was your family status when you started at Columbia Basin College?
11 A single parent with children or other dependents in your care
12 A couple with children or other dependents in your care
13 Without children or other dependents in your care
90 Other
How long have you resided in Washington state?
Years
Months
Were you financially independent from your parent or legal guardian for the
previous calendar year? Yes No
If NO, how long has your parent or legal guardian resided in Washington state?
Years
Months
Are you active duty military, spouse or dependent child of same? Yes No
If YES, when was the active duty military person first stationed in Washington?
Month
Day Year
Are you a higher education employee or dependent? Yes No
Yes No
Last High School Attended City State Year Graduated
Yes No
Last College Attended City State Year Graduated
What is your main long-term goal for attending Columbia Basin College?
11 Take courses related to current or future work
12 Transfer to a four-year college
13 High school diploma or GED
14 Explore career direction
15 Personal enrichment
90 Other
Please mark one or more boxes to indicate
what race you consider yourself to be.
White (800)
African American (870)
American Indian (597)
Alaskan Native (015)
Native Hawaiian (653)
Other Pacific Islander (681)
Vietnamese (619)
Filipino (608)
Chinese (605)
Korean (612)
Japanese (611)
Other Asian (621)
Other Race (Please specify)
Are you of Spanish/Hispanic origin?
No (999)
Yes, Mexican, Mexican American, Chicano
(722)
Yes, Puerto Rican (727)
Yes, Cuban (709)
Yes, Other Spanish/Hispanic/Latino
Please specify
Gold Card (60 yrs and older) Senior Fitness Only (55 to 59 yrs)
Driver’s License/ID Required
Community User - Fitness Center Only
Please complete the box below.
If NOT a U.S. Citizen, what is your immigration status?
Student (F-1) Visitor Immigrant/Permanent Resident (IM)
Other
Student Intent Codes:
A --- General Studies Degree or Certificate
B --- Academic Transfer
D --- High School Diploma/GED Certificate
E --- Development
F --- Occupational Preparatory
G --- Occupational Preparatory Applicant
H --- Occupational Apprentice
J --- Occupational Supplement
K --- Vocational Home and Family Life
L --- General Studies (no degree or certificate)
W --- Community Service
X --- Undecided
Y --- None of the above
For Official Use Only
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REGISTRATION FORM Signatures required as indicated below. Use (Columbia Basin College)

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Completed 21 July 2020

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