Howard Community College

52 Summer 2018 443-518-1700 howardcc.edu/ConEd Noncredit Registration Form PLEASE PRINT NEATLY. NOTE that we do not accept registrations by email. This form will not be processed if submitted by email. FAX: 443-518-4333 (see the other side of this form for mailing info) Signature ________________________________________________________________________________ Date ______________________ I certify that the above information is true and correct, and I request the enrollment change(s) indicated above. All charges due to Howard Community College (HCC) must be paid in full by the published payment due date. Students who are actively enrolled in the Tuition Payment Plan or have financial aid, military Tuition Assistance, veterans' education benefits, third party sponsors, and/or tuition waivers may be able to defer that portion of their balance. If the student's full balance is not covered by these other sources for any reason, the student is responsible for the balance due. Past due balances are subject to collection and fees up to 25% of the original balance. Students whose accounts are delinquent will not be permitted to register for the next term or receive official transcripts and diplomas. HCC may require payment in the form of certified funds, such as cash, money order, credit card, or a cashier's check. FOR FAX-IN OR MAIL-IN: Please note that we do not accept registrations by email. This form will not be processed if submitted by email. (check one) Visa Mastercard AmEx Discover General Information HCC Student ID#: (Please print neatly) ______________________________________ Date of Birth: ___________________ I am over the age of 16 Name: (Last) ___________________________________________________ (First) _______________________________________ (MI) _________ Address: (Street) _____________________________________________________________________________ Apt/Unit: ___________________ City __________________________________________________ State: ________ Zip: _____________ County: __________________________ I have lived at this address for at least three months Home Phone: ________________________________________________ Cell Phone: _________________________________________________ Business Phone: _____________________________________________ Email 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 Registration TDD Gender: Male Female • 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 ___Asian ___Black or African American ___White ___Native Hawaiian or Other Pacific Islander (For race definitions, visit howardcc.edu/categorydefinitions) / / Card#: Expiration Date: Cardholder's Name (Please print legibly): Signature: Students who register by mail or fax will receive an email registration confirmation. I don't want to receive registration confirmation emails. COURSE NO. TITLE START DATE TUITION + FEES (SAMPLE) XE-800 9783 #3492 (SAMPLE) Personal Landscaping (SAMPLE) 11/1/17 (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

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