SENIOR CITIZEN REGISTRATION FORM
CCAC permits senior citizens, dened as persons 65 years of age or order, who are residents of Allegheny County to enroll in up to
two regularly scheduled credit courses each semester without payment of tuition charges. Senior citizen students are encouraged to
take advantage of college advisement services; placement testing may be appropriate. Courses may be taken for credit (graded) or
To qualify for free tuition, each senior citizen student must comply with these conditions:
• Complete a CCAC Application for Admission—transcripts
are not required.
• Enrollment will be based on space availability. CCAC
will only process registrations for senior citizens during
the week prior to the start of the term. Seniors who wish
to register earlier must pay tuition and fees.
• Complete all course prerequisites as identied in the
• Be 65 years of age prior to the rst day of the semester.
• Provide proof of age and Allegheny County residency
(driver's license, birth certicate, tax receipts, etc.).
• The waiver of tuition does not apply to repeated courses.
• Certain college fees are the nancial responsibility
of the student.
• Seniors must purchase their own textbooks and supplies.
• If nancial aid is received in addition to the senior citizen
discount waiver, the senior citizen discount is considered
funding of last resort.
Last Name First Name Middle Name
Street Address CCAC ID or Social Security Number
City State Zipcode
County of Residence Phone Number Email Address
Senior citizens are required to supply a photocopy of their driver’s license or birth certicate along with proof of residence. If applying in person,
college staff will make necessary copies.
CAMPUS COURSE NAME COURSE
M T W H F S U
# CREDITS AMOUNT SEMESTER
REGISTRATION LIMITED TO TWO CREDIT COURSES PER TERM.
*If auditing a course, the student must complete an Audit Agreement Form and submit with instructor signature to Registration ofce. Audited
courses are not eligibile for nancial aid.
I agree that once I register I become legally bound by and agree to the terms of the Community College of Allegheny County Student Financial
Responsibility Agreement, and as such become responsible for all charges incurred, unless I drop classes during the designated refund period. I
understand that the college is extending credit to me and permitting me to register, enroll and attend classes in return for my promise to pay the col-
lege all tuition and fees incurred as a result of my registration, and that such extension of credit constitutes an educational loan or education benet
that is non-dischargeable under Section 523 (a) (8) of the United States Bankruptcy Code. I understand that failure to pay my student account or any
monies due and owing CCAC may result in a nancial hold placed on my account preventing registration for future classes, release of transcripts and
diplomas, and additional college services. Additionally, I understand that failure to pay my student account or any monies due and owing CCAC will
result in a $15.00 late payment fee assessed to my account for each late payment and may result in my account being referred to a third party col-
lection agency resulting in additional fees. Finally, I understand that all delinquent student accounts may be reported to one or more of the national
Student’s Signature Date
Advisor’s Signature Date