Registration Form
12/01/16 HM
Schedule of Courses
•List each course below for which you are registering.
Last Name First Name MI
Semester for schedule adjustment: Year: 20_________
Fall Spring Summer
Overload Approval
Advisor Recommendation
Vice President for Educational Services
Student Signature
Advisor Signature
Admissions and Records
CRN Subject Number Section Days Time Number
of Semes
Credit Audit Pass/
Hours for
Hours for
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Financial Responsibility Agreement and Disclosure Statement
When you initially register as a student at Clovis Community College, you establish an open-end account with the College through its Business
Office. This agreement is a statement of the terms and conditions of that account, as well as a statement of your rights and responsibilities
regarding that account. We recommend that you keep this agreement for your own reference. In the agreement, the words we, our, us,
Institution, CCC and College refer to Clovis Community College. The words you, your and student refer to you, the student. The word
agreement refers to this Agreement and Disclosure Statement.
Applicability Your open-end account is the instrument through which Clovis Community College will process all of your financial transactions
with the College. The terms of this agreement apply to all purchases, charges, fees, fines, tuition and loans made or obtained by you, made or
obtained by someone else with your permission, or assessed to you by, from, or with respect to Clovis Community College (collectively referred
to as Charges and individually as Charge).
Promise to Pay You promise to pay the total amount of all charges. You also promise to pay all finance charges and other fees and expenses
due under this agreement. Your account is not a secured credit account.
Notices You agree to keep us informed of any change in your address. If we mail you a letter, notice, or statement to the last address you have
given us, you agree that you will be bound by the information contained in that mailing. All notices or letters sent to us must be sent to: or
Clovis Community College
Business Office
417 Schepps Blvd
Clovis, NM 88101
Addresses on your account are your responsibility. The addresses on your account may be changed through your Pathway account at You hereby give authority for Clovis Community College or its contracted agents to attempt to contact you via the
use of email, cell phone number, home number, or employment number and/or use any other information supplied to the Institution by
automated or manual communication.
Release of Information Clovis Community College is bound by FERPA regulations, which prohibit our representatives from discussing student
information with other parties. However, the student authorizes the College to release financial or student information related to any outstanding
debt to those concerned with collecting a balance due, or responding to a disputed payment. If a student wishes to share his/her financial
account information with parents, guardians or other interested parties, the student must complete and return the FERPA Waiver form to the
Office of the Registrar. You are personally liable for charges incurred to your student account by other persons designated by you as Authorized
Users per Federal FERPA Law. This form is available at the Admissions & Records Office at Clovis Community College. The FERPA Waiver form
information enables the College to more quickly comply with student and parent requests without jeopardizing the integrity of the account. By
completing this form, you will consent to Clovis Community College disclosing to parties listed all information relating to your Clovis Community
College account. You may revoke this consent at any time by notifying the Registrars Office in writing.
Returned Payments In the event a payment is made on your account and the payment is returned to us unpaid as a result of non-sufficient
funds or otherwise, you agree to pay us a insufficient funds fee of $25.00. The insufficient funds fee is $30.00 if payment has been processed and
returned through TouchNet, our online payment system. Pre-registered classes secured by a returned payment are subject to cancellation.
Credit Limit and Collections You agree not to incur charges in excess of the amount specifically authorized by the College. Clovis Community
College reserves the right to refuse to extend credit, for any reason at any time. Delinquent accounts will be payable to Clovis Community College
until paid in full or until the debt has been turned over to a collections agency or legal authorities for collections. The student is responsible for
any collection costs and/or attorney fees incurred by the collections process. In the case of a delinquent account, your record will be placed on
hold and no transcript shall be issued. Registration for future classes will not be processed and no further credit will be extended until the
account is paid in full.
Miscellaneous This agreement shall be binding to you, your successors, your assignees and/or heirs, and shall inure to the benefit of Clovis
Community College, its heirs, successors and/or assignees. This agreement is delivered in the State of New Mexico and governed by New Mexico
I understand and agree that by clicking on the Accept box (to the left of this message), I am confirming my intent to register for the
courses outlined on this form and this constitutes acceptance of the agreement above.
Student Signature:_________________________________________________________________________Date:________________________
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