Workforce CE STUDENT REGISTRATION FORM

Student Registration Form
Name*

First NameMiddle NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County:*
Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Student ID or Last 4 of Social Security #
Number:*
Birthdate:*

MonthDayYear
Date
Email*
example@example.com
Sex: (Check One)*

MaleFemale
Ethnic/Race: (Check One)*

American/Alaska NativeHawaiian/Pacific IslanderAsianHispanicBlack or African AmericanAsian/Pacific Islander (NP)White
Current Employment Status: (Check one)*

RetiredUnemployed - Seeking40 or more hours21-39 hours11-20 hours1-10 hours
Occupation:
Employer:
Education Level: (Check One)*

Never AttendedAdult High School DiplomaAssociate DegreeGED or High School Equivalency DiplomaBachelor's DegreeCompleted High SchoolOne-Year Vocational DegreeMaster's Degree or Higher
Student Status:

New WCC StudentPrevious/Current WCC Student
Course Information:
Semester:

SpringSummerFall
Year:
Example: 2020
Class Title:*
Class Start Date:

MonthDayYear
Date
Class Time:
Human Resources Development (HRD) Courses ONLY - HRD Verification Statement - Tuition and Fee Waiver
The State Board of Community Colleges grants permission to waive tuition and fees for enrollment in classes coded in the Master Course List as Human Resources Development (HRD) if the individual meets one of the four criteria listed below. To receive this waiver, an individual must verify that he or she meets at least one of the criteria by completing and signing this form. Individuals not signing this form must pay the applicable fee to register for a Workforce Continuing Education course.
I qualify for tuition and fee waiver under the following criteria:

Currently unemployed.Working and eligible for the Federal Earned Income Tax Credit.Received notification of a pending layoff.Working and earn wages at or below 200% of the federal poverty guidelines.
My signature verifies that all the information given by me as written on this HRD Tuition and Fee Waiver Verification information is complete and accurate to the best of my knowledge.

Click to see HRD Fee Waiver Guidelines
SUPPLEMENTAL STUDENT ACCIDENT INSURANCE: As a registered student of a Workforce Continuing Education Course you may purchase Supplemental Student Accident Insurance for $0.55 per semester.

Yes – I would like to purchase Supplemental Student Accident Insurance.No – I would NOT like to purchase Supplemental Student Accident Insurance.
My signature indicates that all information is accurate, and I have read and understand the Refund Policy.
Student Signature:
I certify the above information is true and accurate:*

Clear
*

MonthDayYear
Date
REFUND POLICY FOR WORKFORCE CONTINUING EDUCATION SERVICES COURSES
The refund policy for Workforce Continuing Education Services courses, as established by the N.C. General Assembly, allows a 75 percent refund, after the respective class begins, upon the request of the student if the student officially withdraws from the class prior to or on the 10 percent point of the scheduled hours of the class. A 100 percent refund shall be made if the student officially withdraws prior to the first day of class of the academic semester or term as noted in the college calendar. Also, a student is eligible for a 100 percent refund if the class in which the student is officially registered is canceled due to insufficient enrollment. There are no refunds for self-supporting classes. Under this policy, the college shall notify the student of the right to receive a refund at the time of official withdrawal.
By signing this form electronically, and clicking "Submit", you are agreeing that the electronic representation of your signature is the legal equivalent of your handwritten signature.
Should be Empty:

Student Registration Form

Student ID or Last 4 of Social Security #

Course Information:

Human Resources Development (HRD) Courses ONLY - HRD Verification Statement - Tuition and Fee Waiver

Student Signature:

REFUND POLICY FOR WORKFORCE CONTINUING EDUCATION SERVICES COURSES