Existing student: HRD Registration Form, Central Piedmont Community College

HRD Registration Form

CPCC requires the student Social Security number for internal reporting purposes. Great care is given to safeguarding this sensitive information.
Name*

First NameMiddle InitialLast Name
Former Name
Please leave blank if this does not apply
Central Piedmont Student ID # or last 4 digits of Social Security #*
Semester

SpringSummerFall
Year
County
Date of Birth*

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Cell/Work Number

Area CodePhone Number
Home/Alternate Number

Area CodePhone Number
Race

WhiteBlackNative AmericanHispanicAsianOther
Gender

MaleFemaleOther
Citizenship Country
Student Status

New Central Piedmont StudentPrevious/Current Central Piedmont Student
Current Employment Status*

Full Time (Employed)Part Time (Employed)RetiredUnemployed – Seeking WorkOther
Highest completed Education Level

High School Graduate (12)Adult High School Completion (13)High School Equivalency Diploma (GED/HiSET/TASC)Vocational Diploma (14)Associate Degree (15)Bachelor’s Degree (16)Master’s Degree or Higher (17)Other
HRD Career Profile: List the name of the most recent (or current) company where you work(ed) and your last date of employment. If you have never been employed please type N/A*
Date (month & year) of last employment*
Most Recent Employer Location

Street Address

Street Address Line 2

CityState

Zip Code
Please list the course you want to take. Prefix HRD
Course Section Number
Tuition and Fee Waiver – Verification Statement

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 if the individual meets one of 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 Continuing Education course. I hereby verify that all the information given by me as written on this HRD Tuition and Fee Waiver Verification Form is complete and accurate to the best of my knowledge. Note: The full policy with income guidelines is available here: https://www.nccommunitycolleges.edu/about-us/numbered-memos/cc24-011-2024-hrd-tuition-and-fee-waiver-guidelines/ and there is also an income chart for reference at the bottom of the page.
I qualify for a tuition and fee waiver under the following criteria:*

I am currently unemployedI have received notification of a pending layoffI am working and eligible for the Federal Earned Income Tax CreditI am working and earn wages at or below two hundred percent (200%) of the federal poverty guidelines.I plan to pay for my tuition (not interested in or not eligible for fee waiver)
Student Signature. I certify the above information is true and accurate. *

Clear
Date*

MonthDayYear
Date

Information concerning Central Piedmont Community College’s completion and graduation rates as required by Public Law 101-542, “Student Right-to Know”, will be available in the office of the Dean for Student Development.

Click to see HRD Fee Waiver Guidelines

2025 Poverty Guidelines 200% amounts:

Family Size	Annual Income	Monthly Income
1	$31,300	$2,608
2	$42,300	$3,525
3	$53,300	$4,441
4	$64,300	$5,358
5	$75,300	$6,275
6	$86,300	$7,191

Do not change
Should be Empty:

HRD Registration Form

Tuition and Fee Waiver – Verification Statement