Fillable Registration Form Student contact information Term (Cambridge College Massachusetts)

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Registration Form Student contact information Term (Cambridge College Massachusetts)

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Course #
example: WRT101
Section
example: CA01 Course Title Instructor Credits
Registration cannot proceed if there is an Admissions or Business Oce HOLD.
Registration Form
Term
Fall Spring Summer Year:
AFTER Add/Drop Deadline
Late registration fee is charged.
Get signature* or attach printouts of email
indicating approval to REGISTER for the course(s) above.
Academic dean or
regional center director ________________________________________________________
*Signature not required for students not in a certicate or degree.
Financial aid
—Please contact Student Financial Services to nd out the eect your
add/drop will have on your nancial aid. It may may change your aid for the term. Students
are responsible for any funds that are cancelled, including any refunds already received.
rev. 4/15/20
Registrar's Oce
Cambridge College
500 Rutherford Avenue
Boston, MA 02129
Phone: 617.873.0101
Fax: 617.242.0026
registrar@cambridgecollege.edu
Submit completed and signed form to:
Registrar's Oce
Cambridge College
500 Rutherford Avenue
Boston, MA 02129
Or email to:
registrar@cambridgecollege.edu
Or fax to:
617.242.0026
CC ID Registration Form • page 1 of 2
See back of this printed form (page 2 of pdf) and read carefully.
Both items below must be checked and you must sign
before we can process your add/drop/withdraw.
All students: I have read, understand and agree to the
Student Acknowledgement of Financial Obligation
Students attending MA locations: I have read, understand, and agree to the
Student Health Insurance Requirement
By signing, I acknowledge
that I understand the relevant policies and the
eect of these changes on my nancial aid and tuition liability, and still request to
Add/Drop/Withdraw from my courses as listed on this form.
Sign on paper printout or electronically* ________________________________
Date _____________________________________________________________
*Please see electronic signature options on the Registrar's web page
.
See Policies
www.cambridgecollege.edu/add-drop-policy
www.cambridgecollege.edu/bursar/adding-dropping-courses
Student contact information
PLEASE PRINT CLEARLY and COMPLETE ALL INFORMATION
Last name _________________________________________ First name _________________________________ Middle name _________________________
Current Residence:
Address ______________________________________________ Apt _____________________ Phone ___________________________________
City ______________________________ State _______________ Zip _____________________
Cambridge College email __________________________________________________________________________________________________________________
Student ID#________________________
Your Cambridge College Location
Boston
Lawrence
Springeld
Puerto Rico
Southern California
NEIB
Other_____________
click to sign
signature
click to edit
STUDENT ACKNOWLEDGEMENT OF FINANCIAL OBLIGATION
Students will be required to acknowledge their nancial obligation before formally participating in a semester. An electronic agreement of acknowledg-
ment must be submitted before attending class for any given semester. Students will not be allowed to enroll until the electronic agreement is received.
Student Acknowledgement of F
inancial Obligation:
• By my Enrollment at Cambridge College I acknowledge that I am receiving an educational benet and that the costs associated with that benet are payable
upon the published date specied.
• By registering and checking in for classes at Cambridge College, I acknowledge nancial responsibility for the conrmed courses resulting from this registra-
tion; tuition and all fees assessed to my student account. I also accept responsibility for any additional costs related to my enrollment including, but not limited
to, room, board, and additional credited courses, penalties from withdrawals and other department or college charges.
• I understand that balances due as a result of loss/reduction of nancial aid, or other credits originally anticipated, due to ineligibility, attendance, incomplete
paperwork, etc., will be my responsibility to pay.
• I understand that Cambridge College will place a Bursar Hold on my account if I have not made payment on a timely basis for services received or other
transactions. The Bursar Hold will prevent future registrations, receiving ocial transcripts or diplomas, residing in the resident halls, or any other college
service.
• Should it be necessary for Cambridge College to place my account with a collection agency, I acknowledge that I will be liable for all reasonable collection
agency fees up to 40%, in addition to attorney fees and other applicable charges necessary for the collection of my debt. I acknowledge that contact will be
made by written, verbal, electronic or manual calling methods to telephone numbers and addresses associated with my account currently or in the future. I
also acknowledge that telephone calls regarding my account may be recorded to assure quality and/or other reasons. I acknowledge that Cambridge College
reserves the right to report to credit bureaus.
• I authorize Cambridge College or its agents to contact me at the number listed during this registration on my cell phone or by automated dialing.
All students: I have read, understand and agree to this
Student Acknowledgement of Financial Obligation
HEALTH INSURANCE REQUIREMENT
Students attending Massachusetts locations
Students attending Massachusetts locations are required by the State of Massachusetts to have health insurance if they are a graduate student taking six or
more credits, or an undergraduate student taking nine or more credits. All international students are required to have health coverage regardless of the credit
load they are taking. If a student is agged for SEVIS, the health insurance charge is added.
Students are provided an opportunity to waive the health insurance if they have a qualied health plan. All student-owned health plans must be eective on
the rst day of the rst month for which the term begins. (Fall coverage must be eective by Sept. 1, spring coverage must be eective by Jan. 1 and summer
coverage must be eective June 1.) Students are required to submit proof of coverage using the online portal through Gallagher Koster, and the waiver request
must be submitted by the established deadline. Should a student fail to submit the waiver request, does not have a plan that meets the state’s minimum require-
ment, does not meet the eective date, or fails to provide substantiating documents as requested by the established deadline, the student is fully responsible for
the cost of the health insurance charge.
By continuing into the registration process, you acknowledge that you have read the Health Insurance Requirement. You conrm that you understand the Health
Insurance requirement and that you agree to abide by the terms. You agree to hold Cambridge College blameless and harmless in the event that you the stu-
dent, do not abide by the established requirements and deadlines of the Health Insurance Requirements.
Students attending MA locations: I have read, understand, and agree to this
Student Health Insurance Requirement
page 2 of both: Registration Form, Courses: Add/Drop/WD form
Registration Form • Add/Drop/Withdraw Form • page 2 of 2
rev. 04/13/20
Registration Form • Courses: Add/Drop/Withdraw
Student name _______________________________________________________________________________
Student ID#
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Completed 20 May 2021

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