Middlesex Community College Registration Form for Community Education

MCC Registration Form for Community Education (noncredit) classes Only.

For all other programs, call 800-818-3434.

For Questions on Community Education classes email: career_training@middlesex.edu

After completing this form for Community Education classes, remember to click the Submit button. Once your information is received, within 1 to 2 business days you will receive an email to confirm your registration and provide you the next steps for payment.

Student Information

Last Name

First Name

Middle Initial

Legal Sex

FemaleMale

Date of Birth (Month/Day/Year)

Current Address ( Street Number and Name)

City

State

Zip Code

Phone Number (Cell)

Phone Number (Home)

E-mail

Course Registration Information

Term

SpringSummerFall

Year of Term

Course# and Section#

CRN#

Course Dates

Course Title

Course# and Section#

CRN#

Course Dates

Course Title

Course# and Section#

CRN#

Course Dates

Course Title

Course# and Section#

CRN#

Course Dates

Course Title

Course# and Section#

CRN#

Course Dates

Course Title

Ethnic Group

Ethnicity: Are you of Hispanic or Latino origin?

YesNo

Race: Choose one or more from the list below:

High School Information

Did you earn a High School Diploma?

YesNo

HiSET or GED?

YesNo

Emergency Contact

Contact Name

Relationship

Phone Number

I certify that all information on this form is accurate and complete.

Applicant's Signature

Date

Parent/Guardian's Signature (if under age 18)

Date

Students requesting access classroom support/access services should contact StudentAccess@middlesex.edu or 781-280-3630

Acknowledgement

Please read and agree by checking the box

I understand and acknowledge that by completing this course registration form I will be enrolled and agree to the MCC Community Education course refund policy.

Course Drop or Withdrawal: Students MUST notify Community Education in writing via email: Career_Training@middlesex.edu

Program instructors are not responsible for reporting decisions to withdraw or non-attendance. Lack of attendance, course abandonment, or failure to make or complete payment does not constitute official course withdrawal and students will be charged for the course. This applies to all Community Education online and on-campus class enrollment. Refunds are applied according to MCC’s Community Education refund policy. For complete refund schedule details visit:

https://www.middlesex.mass.edu/careertraining/refund.aspx