Howard Community College

Social Security or HCC Student ID #: _____________________________________ Name:______________________________________________________________________________________________________ Last First M.I. Address: ____________________________________________________________________________________________________ Street City State Zip County I have lived at this address for at least three months. Date of Birth: ____/____/____ I am over the age of 16. Gender: Cell or Home Phone: (_______) ______________________________ Work Phone: (_______) ___________________________________ E-Mail Address ____________________________________________ My information has changed since my last registration: name address phone email I have previously taken a class at HCC. I am a Maryland resident age 60 and older and qualify for a tuition waiver. Not applicable to XE courses or fees. COURSE NUMBER Title Tuition XE-800 9783 #3492 SAMPLE Personal Landscaping SAMPLE $ 65 ___________________________________ __________________________________________________ _______________ __________________________________ __________________________________________________ _______________ ___________________________________ __________________________________________________ _______________ ___________________________________ __________________________________________________ _______________ Out-of-county Maryland residents add $10 per course. _______________ Residents outside Maryland add $20 per course. _______________ SENIORS: (Maryland residents ages 60 and older only): Pay all fees listed in the course description. Exception: For XE courses, pay the full amount listed at the end of the course description. Total _______________ Signature: ______________________________________________________________ Date: ____________________________ I certify that all of the above information is true and correct. ✃ Noncredit Registration Form PLEASE PRINT NEATLY Please note that we do not accept registrations by email. This form will not be processed if submitted by email. Online: Visit hccexpress.net. Fax-in: Fax this form & credit card info. to: 443-518-4333. Allow 2 days for processing. Walk-in: Bring form and payment to the Registration Office, Student Services Bldg. Hours: 8:45 a.m.- 7 p.m. Monday through Thursday; 8:45 a.m.- 5 p.m. Friday. Mail-in: Send registration form and credit card information or check to: Howard Community College, 10901 Little Patuxent Pkwy, Columbia, MD 21044- 3197, ATTN: Lock Box Cashier, RCF-203. Include address, home and business phones on check. Allow 1 week to process. FOR FAX-IN OR MAIL-IN: Visa, MasterCard, American Express, Discover (circle one) Card # Exp. Date Cardholder's Name (Please print legibly ) Signature Are you of Hispanic or Latino origin? Yes___ No___ What is your race? Select one or more of the following categories: ___American Indian or Alaska Native ___Native Hawaiian or Other Pacific Islander ___Asian ___White ___Black or African American For race definitions, visit www.howardcc.edu/visitors/Webmaster/race_ethnicity.html Students who register by mail or fax will receive an email registration confirmation (printed confirmations will no longer be mailed). I do not want to receive registration confirmation emails. ___Male ___Female

• Cover