REGISTRATION FORM HOW TO REGISTER BY PHONE: 216-987-0233 Have credit card information available.
IN PERSON You may register in person at any Tri-C Enrollment Center. See http://www.tri-c.edu/enrollment-center/ for hours of operation.
BY MAIL Complete registration form. Mail with check, money order, credit card information or purchase order to: Corporate College East 4400 Richmond Road Warrensville Heights, Ohio 44128
• Brunswick University Center 3605 Center Road Brunswick, OH 44212
• Metropolitan/Advanced Technology Training Center 3409 Woodland Ave. Cleveland, OH 44115
• Westshore Campus 31001 Clemens Road Westlake, OH 44145 • Corporate College® East 4400 Richmond Road Warrensville Hts., OH 44128 • Corporate College® West 25425 Center Ridge Road Westlake, OH 44145
• Metropolitan/Unified Technologies Center 2415 Woodland Ave. Cleveland, OH 44115
BY FAX: 216-987-2957 To register and pay with credit card or purchase order. For complete registration information, including cancellation, refund, withdrawal and substitution policies, please visit: http://www.tri-c.edu/corporatecollege/ register-for-classes/registration-policies.html
• Eastern Campus 4250 Richmond Road Highland Hills, OH 44122 • Western Campus 11000 Pleasant Valley Road Parma, OH 44130
Note: Effective Oct. 1, 2015, credit cards will no longer be accepted in person at the registration window. Payment may still be made by check, money order or cash.
PERSONAL INFORMATION Name_______________________________________________________________________ Last
First
Date of Birth:
Tri-C ID (S#) if known:
Last four digits required*
Complete this area if you are a new student or if any information has changed.
Apt. No.
Cell Phone
-
-
-
OPTIONAL
Area Code
Gender:
Male
U.S. Citizen:
Yes
No
Female
Are You a Veteran:
Yes
No
Ethnic Background: BLACK
Area Code
Email _______________________________________________________________________ Have you ever been convicted of a sexual related offense or a violent crime against a minor? Yes No
BUSINESS OR WORK INFORMATION
WHITE (NON-HISPANIC)
ASIAN, PACIFIC ISLANDER, OR INDIAN SUBCONTINENT
HISPANIC
OTHER
Complete this area if you are a new student or if any information has changed.
Business Name__________________________________________________________
- -
Phone Area Code
Address_________________________________________________________________ Number
AMERICAN INDIAN OR ALASKAN
Ext.
Street
____________________________________________________________________________________ City State Zip County
- -
Fax Area Code
PAYMENT INFORMATION Bill Company, via attached purchase order MasterCard Visa Discover Amer. Express COURSE NO.
Account Number Name on Card Signature COURSE TITLE
Check (enclosed)
IMPORTANT PAYMENT INFORMATION
Money Order (enclosed) Security Code Exp. Date If registering for an ONLINE course, start date is required. START DATE
FEE
Effective July 15, 2014, a 2.4 percent service fee will apply to all payments made by credit card for Cuyahoga Community College (Tri-C®) credit and non-credit tuition, fees and other student account charges. Call 216-987-0233 if you have any questions.
For complete course listing: www.tri-c.edu/workforce • To register call 866-933-5175 • Fall 2014 - 29 - TOTAL Signature (required)
15-0723
29
-
Year
S
________________________________________________________________________________________ City State Zip County
Home Phone
Day
*Tri-C ID Information: Students will no longer need to use their social security number as a primary ID, but it may still be required as part of your record. Additional information is available at www.tri-c.edu/tricid. Choose “Frequently Asked Questions for Students.” Or call 866-933-5175.
Address_____________________________________________________________________ Street
-
Month
Social Security Number
Number
-
M.I.