NON-CREDIT Registration Form
This form may be duplicated One form per person NO registration will be accepted by phone.
This form is used for . . .
NON-CREDIT CLASSES: Registration for Non-Credit classes will be accepted ONLY if you have previously attended VVC.
NEW STUDENTS:
A new student must apply for Admission before registration will be accepted.
This form is not used for credit classes. No credit class registration will be accepted.
1. Complete information must be on registration form and return by mail, or in person, at lease oneweek prior to semester start date. All information must be complete or registration WILL NOT be accepted. 2. Mail completed form to: Admissions and Records Office Victor Valley College 18422 Bear Valley Road Victorville, CA 92395-5850 OR. . . 3. Register in person at Victor Valley College Admissions and Records Office in Student Services 1, Building 52.
USE THIS FORM FOR NON-CREDIT REGISTRATION ONLY
PLEASE PRINT CLEARLY
Mail to: Victor Valley College Admissions and Records Office 18422 Bear Valley Road Victorville, CA 92395-5850
Social Security Number ________________________ Birthdate: Mo/Day/Year
Sex:
Female
Male
NON CREDIT
__________________________________________________________
Last Name Mailing Address First City Middle
________________
Day Phone Zip
________________
Evening Phone
CLASSES
________________________________________________________________________________________________
State
Predominant Ethnic Background 10 White Non-Hispanic 28 Laotian 28 Cambodian 27 Vietnamese 21 Chinese 28 Other Asian 22 Filipino 26 Pacific Islander 23 Indian subcontinent (Tahiti, Fiji, Marshall I) 24 Japanese 26 Hawaiian 25 Korean 26 Samoan
Starting Date
26 Guamanian 30 Black, Non-Hispanic 42 Mexican, MexicanAmerican 41 Cuban 43 Puerto Rican 44 Other Hispanic 44 Central American
Fee Instructor
44 South American 50 Middle Eastern (e.g.
Arabian, Iranian)
60 American Indian/
Alaska Native
70 Other Non-White 99 Unknown
Check appropriate box for following: have you been in continuous residence in the State of California for more than one year: Yes No Date residence began in California ____________________________ Month/Day/Year
FOR OFFICE USE CE ____ CS ____ Received by _____________________ Date ___________________________ CK _____ NO. __________________
Section #
Course Name
ASB Fee _________
_____________________________________________
Student Signature Date
Registration Fee $_________ Parking Fee $_________ TOTAL Amt. Enc. $_________
Check/Money Order VISA/MC Discover _______________________
Shading denotes evening classes.
Amer Ex Credit Card No. _________________________ Exp. Date _______