Revised June 27, 2016
STUDENT REGISTRATION FORM
Name:
ID # :
900 - ___ ___ ___- ___ ___ ___
Home Address:
Phone:
City, State, ZIP:
Major:
REGISTER OR ADD CLASSES
Subject Code/
Course No.
Course Reference #
Section No.
Cr. Hrs.
Signature is good for 24 hours unless noted.
Office Use Only
Office Use Only
Prereq OK
+Max Seats
OK
Example:
ENG 101
11505
001
3
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DROP CLASSES
Subject Code/
Course No.
Course Reference #
Section No.
Cr. Hrs.
Instructor Signature (when needed)*
Signature is good for 24 hours unless noted.
Example:
ENG 101
11505
001
3
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By signing this form, you are acknowledging that you understand and agree to the following terms and conditions put forth by Black Hawk College.
I acknowledge that I am entering into a legal binding contract with BHC to pay all tuition and fees for this semester by the payment due date, whether or not a bill has been
received. If I withdraw or drop class/classes after the refund period (see www.bhc.edu/refund), then I am financially obligated to pay for the courses, even if I have never
attended any class sessions.
All past due accounts are subject to a late fee of $25.00 per month or maximum of $75.00 per semester. The responsible party promises to pay for services in accordance with
the above terms. If, at any time, for any reason, the responsible party is unable to pay for services when due, the responsible party agrees to pay and authorizes BHC to bill their
account late fees, as described above. In the event it becomes necessary for BHC to incur collection costs or institute suit to collect any amount due under this agreement, the
responsible party shall be responsible for charges incurred, to pay all additional costs, charges, collection fees and expenses, including reasonable attorneys’ fees and costs, if
incurred for the collection or otherwise and submits to jurisdiction and venue in Rock Island County, Illinois.
Student Signature (required) ___________________________________Date____________ BHC Staff _________________Date______________
Parent Signature (if student is under 18 years old) ______________________________________________________________ Date____________________________
FINANCIAL AID RECIPIENTS: Financial aid is based on attendance for the entire semester. Dropping will affect your completion rate and may result in
an overpayment of aid. You are advised to talk with Financial Aid to withdraw from class after the semester has begun.
*Advisor signature needed:
*Instructor signature needed:
●if adding after term has started, but class has not yet met
●if adding after start of class
●if dropping after 75% of class has been completed
You must notify Enrollment Services immediately if your major or address has changed by filling out appropriate form
available in Enrollment Services or you may send an email from your myBlackHawk account to: registrar@bhc.edu
Term: _________
click to sign
signature
click to edit
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