WINTER/SPRING/SUMMER 2020 Community Education Course Registration Form
ONLINE REGISTRATION: www.necc.mass.edu/community-education
PHONE REGISTRATION: 978-556-3700
MAIL REGISTRATION TO: Enrollment Services, NECC, 100 Elliott Street, Haverhill, MA 01830
We ask that you provide the following information in order to avoid multiple
transcripts at NECC and to accurately capture your enrollment.
NECC Student ID No. (if known) Date of Birth (REQUIRED)
Last Name First Name Middle Init.
Mailing Address Number and Street City State ZIP
Email Address
Home Phone Work Phone Cell Phone
FOR INFORMATION COME TO OR CALL
Behrakis Student Center, Haverhill
Campus: 978-556-3700
Individuals who are deaf or hard of hearing may
contact any NECC office via the relay service by
dialing 7-1-1 (TTY) or through the Video Relay
Service (VRS) of their choice.
Services for students with disabilities or who are
Deaf or Hard of Hearing — Please contact or visit:
The Learning Accommodations Center: Behrakis
One-Stop Student Services Center, SC-111,
978-556-3654, lacenter@necc.mass.edu
Deaf and Hard of Hearing Services: Behrakis One-
Stop Student Services Center, SC-110, 978-241-7045
(VP/Voice), deafservices@necc.mass.edu
Have you ever taken a noncredit or credit course at NECC? ❑ Yes ❑ No Please list any/all previous names________________ ____________________ __________________
Previous address and/or business address__________________________________________________________________________________________________________________________
Please check appropriate responses. Data is confidential and used for state and federal reporting purposes only.
❑ Male ❑ Female
RESIDENCY: ❑ Massachusetts Resident❑ Out-of-State Resident CITIZENSHIP: ❑ US Citizen ❑ Non-resident Alien (Needs I-20) ❑ Resident Alien
RACE/ETHNICITY:
Please answer both A. and B.
A. ETHNICITY: Are you of Hispanic or Latino origin? ❑ Yes ❑ No
B. RACE — choose one or more:
❑ African-American/Black ❑ American Indian/Alaska Native ❑ Native Hawaiian/Pacific Islander ❑ Asian ❑ Cape Verdean ❑ White/Caucasian
NONCREDIT COURSE SELECTIONS
Capital Materials
CRN # Course Number - Section # Course Title Cost Total for All
Fee Fee
Registration Instructions: List the cost and fees (if any) for each course. Total the cost of all course fees across then
down. CHECK THE REFUND POLICY BEFORE REGISTERING.
COST
Payment Instructions
Calculate TOTAL COST including fees (above) and remit payment IN FULL by check (made out to NECC), or by
company purchase order. Credit cards (Discover, MasterCard, Visa, and American Express) accepted for online
or phone registrations only. Write Student ID number on the face of check.
Payment Type: ❑ Check ❑ Attached Purchase Order. Bill my organization, attention______________________
CHECK THE REFUND POLICY BEFORE REGISTERING.
Noncredit Course Policies: Cost/Refund/Registration
COST OF ATTENDANCE Cost for noncredit courses varies and is listed with each course description. A materials
fee (also listed with course descriptions) may be required in some courses.
Please Note: A $10 Capital Fee is charged to specialized non-credit courses for the upgrading of classrooms
and laboratories.
NONCREDIT REFUND POLICY A full refund (including fees, if any) will be given for a noncredit course that is
dropped six or more days before the start of the class. A full refund is also given if NECC cancels the course for
any reason.
See other policies on inside cover
See WWW.NECC.MASS.EDU
OFFICE USE ONLY
AMT REC’D
DATE
BY
REGISTRAR
DATE
TERM
AMT CHRG’D
DATE
BURSAR
NOTE: Northern Essex Community College’s Center for Corporate & Community Education reserves the right to cancel
any class or change information contained within this brochure as may be required due to error, instructor schedule
changes or other unforeseen circumstances.
