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SUMMER 2011 COURSE BULLETIN - page 15 / 16

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(413) 552-2745

Kittredge Center, 2nd floor, Customer

Service Lobby (413) 552-2500

www.hcc.edu/ces

Non-credit Registration-Kittredge Center Holyoke Community College 303 Homestead Avenue Holyoke, MA 01040

Non-credit Enrollment Form

(413) 538-5815 24 hours a day

Note: Many courses fill fast. We suggest you register at least two weeks before class start date, or by registration deadline if noted. If space is still available in a class, HCC can accept registration for most classes up to the business day before a class starts.

Full payment for all non-credit courses is due at time of registration.

1. About You

Gender:

M

F

Area Code Phone Number

Work/Day

Email: ___________________________________________ Previous Name (If applicable)

Date:__________ Date of Birth

Home/Evening

Last Name

First Name

Street Address

City

State

Zip Code

2. Class Selections

Emergency Contact Information:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Course Number

CRN*

Section

Course Title

Day/

Non-credit

Time

Tuition

How did you learn about this course? Please check all that apply

On HCC’s website Received Community Education Bulletin ...

  • *

    CRN: Course Registration Number

Total

Please help us comply with state & federal reporting by indicating the ethnic group with which you identify.

  • 1.

    What is your ethnicity? Hispanic or Latino Not Hispanic or Latino

  • 2.

    Select one or more races to indicate what you consider yourself to be:

American Indian or Alaskan Native Asian Black or African American Cape Verdean Native Hawaiian or Pacific Islander White

3. With which ethnic group do you identify? American Indian Black, Non-Hispanic Asian or Pacific Islander Hispanic White, Non-Hispanic Cape Verdean

in mail picked up on campus Received any other mailing about courses and programs Via an email

Saw an ad or story in the newspaper

Other: (please indicate)

_ _________________________

3. Employer Information

4. Payment

Charge Accounts

Employer:_________________________________________________________________

We accept MasterCard, Visa and Discover. Complete all items below if you are charging a course or registering by Fax.

Your job title:______________________________________________________________

Business address:

__________________________________________________________

Account Number:

_______________________________________________________

Work Phone:

Work Fax:

Work email:

____________

_______________

______________

Date of Expiration:

______________________________________________________

Is your employer reimbursing you for the cost of this course?

Yes

No

Signature:

________________________________________________________

Questions Call (413) 552-2500

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