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REGISTRATION FORM
*Mail/bring completed form to: Student/User ID #:_____________________________ Northern Virginia Community College (required) Office of Continuing Education – CE 202 Birth Date: ___________________________________ 8333 Little River Turnpike Annandale, VA 22003-3796 Home Phone: ( ) ____________________________
Day/Work Phone: ( ) __________________________
NAME________________________________________________________________________________________ (First) (M.I.) (Last)
ADDRESS_____________________________________________________________________________________ (Street) (Apt #)
______________________________________________________________________________________________ (City) (State) (Zip Code)
Current E-mail Address:_________________________________________________________________ (Used only for class-related notification purposes.)
(See course example in color below.)
*Employer’s Federal I.D. #: ________________________________________________ (For tuition assistance billing and refund purposes only)
OFFICE USE: Reg. Processed: Date ______ Time ______ Initials _______ Service Indicator ______ |
Payment is required at the time of registration. Enclose your check or money order (payable to NVCC). Cash payments should be made to the Annandale Campus Business Office in CG 220. The Continuing Education Office in CE 202 will accept payments when the Business Office is closed. Credit card payments must be made on the Web. See page for additional registration/payment details. If you have questions, please call us at (703) 323-3168.
Check/Money Order enclosed _______