Visiting Student Enrollment Request
LFCC Admissions / Enrollment Services Office
173 Skirmisher Ln · Middletown, VA 22645
Telephone: 540-868-7110 Email: admissions@lfcc.edu Fax: 540-868-7005
Revised 10/17/2019 WHITE
For office use only
Electronic signature verified by: _________________ Processed by: _____________ Date __________________
Semester: □ Fall □ Spring □ Summer Year: 20____ Location/Campus
Student ID# Date of Birth
Name
Last First Middle
Phone Email @email.vccs.edu
I am a: ☐ Transient Student (Primarily enrolled at another institution but taking classes at LFCC to
transfer back to the primary institution)
☐ Post Degree Student (Have earned an associate degree or higher)
☐ I am an F1Visa holder (Attach permission letter from primary institution for immediate
processing)
Enroll or Add
Class # Subject Course # Section Course Title Credits
12345 HIS 112 00A U.S. History I (example) 3
LFCC recommends taking Part I before taking Part II of any sequenced course. LFCC is not responsible
for the outcome of any course not taken in the correct sequence or without the suggested pre-
requisites.
I understand that the courses may not transfer back to my primary institution or school division (if
seeking re-certification) if I have not worked with an appropriate school official.
Visiting students are NOT eligible for financial aid at LFCC.
Student’s Signature: Date:
I voluntarily consent to the use of an electronic record of my LFCC student file. I acknowledge that, by logging into the MYLFCC system with my unique credentials and e-
mailing from my @email.vccs.edu account to provide LFCC with this data, I have given my electronic signature which has the same legal and binding effect as a "wet" or
handwritten signature.
