CEWD REGISTRATION/DROP FORM [email protected]| 410-777-4325 (fax) In support of social distancing, this registration form has been customized to be submitted by email to [email protected] or by fax to 410-777-4325. To protect your sensitive information, you cannot include your birth year or credit card information on this form. One of our staff will call you to verify your identity and collect the missing information over the phone once submitted. Online registration is available; instructions provided at www.aacc.edu/noncredit STUDENT INFORMATION AACC ID NUMBER OR LAST 4 OF SOCIAL STUDENT’S LEGAL LAST NAME STUDENT’S LEGAL FIRST NAME MIDDLE INITIAL OTHER LAST NAMES USED (IF ANY) HOME STREET ADDRESS CITY STATE ZIP CELL BUSN HOME CELL BUSN HOME / COUNTY PRIMARY PHONE NUMBER REQUIRED SECONDARY PHONE NUMBER MONTH / DAY OF BIRTH F M GENDER EMAIL ADDRESS CITIZENSHIP (SELECT ONE) REQUIRED RESIDENCY (SELECT ONE) REQUIRED ETHNICITY/RACE (SELECT ALL THAT APPLY) I am a United States citizen. I am a permanent alien resident*. I have a visa*; visa type _______________________. Country of foreign citizenship __________________. *Original documentation must be submitted in person before any registrations can be processed. I have maintained my legal domicile… in Anne Arundel County for at least 3 months. in Maryland for at least 3 months. not in the state of Maryland. Hispanic or Latino: YES NO American Indian or Alaska Native Asian Black or African-American Native Hawaiian or other Pacific Islander White CERTIFICATE AND COURSE INFORMATION FALL WINTER SPRING SUMMER NONCREDIT CERTIFICATE CODE TERM OF THIS REGISTRATION/DROP YEAR ACTION SECTION ID TITLE OF COURSE START DATE DAYS OF WK TIMES LOCATION COST “REGISTER” or “DROP” ABC-123-456 ABCs of Business Analytics Sept. 28 MWF 10am - 12:30 pm CCPT $$$ QUESTIONS? Out-of-county residents add $10 per class; Out-of-state residents add $25 per class. Email [email protected]or visit www.aacc.edu/noncredit TOTAL COST PAYMENT INFORMATION (PAYMENT IS DUE AT THE TIME OF REGISTRATION) (NO REFUNDS ARE GIVEN AFTER A CLASS HAS STARTED) The security of all members of the campus community is of vital concern to Anne Arundel Community College. Information concerning campus security and crime statistics is available in the Student Handbook. For copies write: Anne Arundel Community College, Department of Public Safety, 101 College Parkway, Arnold MD 21012-1895. Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual misconduct, discrimination or harassment, contact the federal compliance officer/Title IX Coordinator at 410-777-1239 or [email protected] or Maryland Relay 711. CHARGE MY: AMERICAN EXPRESS DISCOVER MASTERCARD VISA We are only able to accept credit card payments for registrations submitted by email. REQUIRED STUDENT SIGNATURE I certify that the information I have given on this form is accurate and complete. By proceeding with this registration I agree to abide by the Academic Integrity Policy and all other college policies as cited in the college catalog. ENTER STUDENT NAME and PARENT/GUARDIAN NAME (IF STUDENT UNDER 16 YEARS) AS SIGNATURE DATE MM/DD/YYYY It is understood and agreed by entering your name here you are hereby responsible and obligated to pay for the above courses. Modification Date: 2020.04.07
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In support of social distancing, this registration form has been customized to be submitted by email to [email protected] or by fax to 410-777-4325. To protect your sensitive information, you cannot include your birth year or credit card information on this form. One of our staff will call you to verify your identity and collect the missing information over the phone once submitted.
Online registration is available; instructions provided at www.aacc.edu/noncreditSTUDENT INFORMATION AACC ID NUMBER
OR LAST 4 OF SOCIAL
STUDENT’S LEGAL LAST NAME STUDENT’S LEGAL FIRST NAME MIDDLE INITIAL OTHER LAST NAMES USED (IF ANY)
HOME STREET ADDRESS CITY STATE ZIP � CELL � BUSN � HOME
� CELL � BUSN � HOME /
COUNTY PRIMARY PHONE NUMBER REQUIRED SECONDARY PHONE NUMBER MONTH / DAY OF BIRTH
� F � M GENDER EMAIL ADDRESS
CITIZENSHIP (SELECT ONE) REQUIRED RESIDENCY (SELECT ONE) REQUIRED ETHNICITY/RACE (SELECT ALL THAT APPLY) � I am a United States citizen. � I am a permanent alien resident*. � I have a visa*; visa type _______________________. � Country of foreign citizenship __________________. *Original documentation must be submitted in person before any registrations can be processed.
I have maintained my legal domicile… � in Anne Arundel County for at least 3 months. � in Maryland for at least 3 months. � not in the state of Maryland.
Hispanic or Latino: � YES � NO � American Indian or Alaska Native � Asian � Black or African-American � Native Hawaiian or other Pacific Islander � White
CERTIFICATE AND COURSE INFORMATION� FALL � WINTER � SPRING � SUMMER
NONCREDIT CERTIFICATE CODE TERM OF THIS REGISTRATION/DROP YEAR
ACTION SECTION ID TITLE OF COURSE START DATE DAYS OF WK TIMES LOCATION COST “REGISTER” or “DROP” ABC-123-456 ABCs of Business Analytics Sept. 28 MWF 10am - 12:30 pm CCPT $$$
QUESTIONS? Out-of-county residents add $10 per class; Out-of-state residents add $25 per class.
PAYMENT INFORMATION (PAYMENT IS DUE AT THE TIME OF REGISTRATION) (NO REFUNDS ARE GIVEN AFTER A CLASS HAS STARTED)
The security of all members of the campus community is of vital concern to Anne Arundel Community College. Information concerning campus security and crime statistics is available in the Student Handbook. For copies write: Anne Arundel Community College, Department of Public Safety, 101 College Parkway, Arnold MD 21012-1895.
Notice of Nondiscrimination: AACC is anequal opportunity, affirmative action,Title IX, ADA Title 504 compliantinstitution. Call Disability SupportServices, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request mostaccommodations. Requests for signlanguage interpreters, alternative formatbooks or assistive technology require 30days’ notice. For information on AACC’scompliance and complaints concerningsexual misconduct, discrimination orharassment, contact the federalcompliance officer/Title IX Coordinator at410-777-1239 [email protected] or MarylandRelay 711.
CHARGE MY: � AMERICAN EXPRESS � DISCOVER � MASTERCARD � VISA
We are only able to accept credit card payments for registrations submitted by email.
REQUIRED STUDENT SIGNATURE I certify that the information I have given on this form is accurate and complete. By proceeding with this registration I agree to abide by the Academic Integrity Policy and all other college policies as cited in the college catalog.
ENTER STUDENT NAME and PARENT/GUARDIAN NAME (IF STUDENT UNDER 16 YEARS) AS SIGNATURE DATE MM/DD/YYYYIt is understood and agreed by entering your name here you are hereby responsible and obligated to pay for the above courses.