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Non-credit Registration Form

*Items preceded by an asterisk are required.

(Choose correct term)     *Semester:  *Year:(yyyy)

Name:
*Last:    *First: M.I.:
*Mailing Address:
Street: City: State: Zip:
Permanent Address:(if different from mailing address)
Street: City: State: Zip:

*County:

*Home Phone: ()-- Cell Phone: ()--
Business Phone: ()--

*E-mail Address:

*Sex: *Ethnicity 1: *Race:
  *Date of Birth: (mm/dd/yyyy)
1 SCCC is required pursuant to Section 806B of Regulation (45 CFR 80) to furnish the information requested to the U.S. Department of Education under Title VI, Civil Rights Act of 1964. This information will be used for statistical purposes only.

*U.S. Citizen:
*Goals:

Last college attended prior to SCCC:
Year:(yyyy)

Please check this box if above information has changed since your last registration.

COURSE SCHEDULE
       
CRN# CFP or CFE Number Days/Times/Building/Room  

Thank you for your submission. Once we have completed your registration you will receive an e-mail with payment instructions. Please call the Office of Workforce Development and Community Education at (518) 595-1101 ext. 3 or 4 with any questions.




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