Enrollment Form Part 2 OLD

Paris Junior College
Enrollment Form
Paris Junior College 2400 Clarksville Street Paris, Texas 75460-6298
Paris Junior College - Sulphur Springs Center 1137 East Loop 301 Sulphur Springs, Texas 75482
Paris Junior College - Greenville Center 6500 Monty Stratton Pkwy. Greenville, Texas 75401
Continuing Education
To register by mail, complete this form and make check payable to Paris Junior College.
PART 1 - STUDENT DEMOGRAPHIC INFORMATION
SOCIAL SECURITY NUMBER*
BIRTH DATE*

MonthDayYear
Date
Last*
First*
Middle
HOME ADDRESS*
CITY/STATE/ZIP*
COUNTY
HOME PHONE NUMBER*

Area CodePhone Number
WORK PHONE NUMBER

Area CodePhone Number
E-mail Address*
example@example.com
ETHNIC

(1) White(4) Asian or Pacific Islander(2) Black or African American(5) American Indian or Alaska Native(3) Hispanic or Latino(6) Nonresident Alien
GENDER

MaleFemale
REFUND POLICY:If a class is cancelled for insufficient enrollment, you will receive a 100% refund. If you drop a class 24 hours prior to the first scheduled class day, you will receive a 100% refund. Request made before the second scheduled class day, you will an 80% refund. Should you cancel after that time, no refund will be issued. Please allow 4 to 6 weeks for your refund to be processed.
Signature*

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Paris Junior College gives equal consideration of all applicants for admission, without regard to race, color, religion, creed, national origin, sex, age, marital status, handicap or veteran status. Assistance is provided to students with limited English speaking abilities, or learning difficulties. For further information, contact the Advising and Counseling office at 903.782.0426.
PART 1 - PARTICIPANTS PAYMENT INFORMATION
Credit Card Number*
Exp Date*
CVS Code*
Cardholders Name*

First Name, Middle NameLast Name
Business Name (IF APPLICABLE)
Biling Address*
City, State, Zip*
"I, authorize Paris Junior College Workforce to manually process my credit/debit card for the amount of $225.00 to purchase a placement to their onsite course work. I understand that my card information will be handled securely in compliance with the Payment Card Industry Data Security Standard (PCI DSS I consent to the processing of my card information for this transaction and agree to Paris Junior College data retention policy. I also understand my right to revoke consent or dispute charges as per applicable laws."

REFUND POLICY: If a class is cancelled for insufficient enrollment, you will receive a 100% refund. If you drop a class 24 hours prior to the first scheduled class day, you will receive a 100% refund. Request made before the second scheduled class day, you will an 80% refund. Should you cancel after that time, no refund will be issued. Please allow 4 to 6 weeks for your refund to be processed.
Signature*

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Paris Junior College

Enrollment Form

Paris Junior College 2400 Clarksville Street Paris, Texas 75460-6298

Paris Junior College - Sulphur Springs Center 1137 East Loop 301 Sulphur Springs, Texas 75482

Continuing Education

PART 1 - STUDENT DEMOGRAPHIC INFORMATION

PART 1 - PARTICIPANTS PAYMENT INFORMATION