Community Education Registration Form

In the spaces provided below, enter your information and/or select desired items.  After completing and submitting the form, you will receive a confirmation email within 48 business hours.  This form will not automatically enroll you into the class(es).  Staff will enroll you if space is available.

I am a:
New Student Returning Student

For what quarter:
 Summer   Fall   Winter    Spring

Student ID Number (new students will be assigned an SID#):

Gender (F/M):

Birth Date (mm/dd/yy):


Last Name, First Name, Middle Initial:

Mailing Address:

City, State, Zip:

Day Phone Number (include area code):

Evening Phone Number (include area code):

E-Mail Address:

Which race do you consider yourself to be?
 White/Caucasian Black/African-American
Alaskan Native or American Indian Chinese Filipino
Korean Vietnamese Japanese
Other Asian or Pacific Islander Other race

Are you of Spanish or Hispanic origin: Yes No

What class or classes would you like to take?

Item # (ex. 1182)Dept/Number (ex. CE 106)

Enter comments or additional information below:

Print this form to mail with your payment
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Contact

Community Education Office
Forrest Stepp
Hawks Prairie Room 107
(360) 596-5365
fstepp@spscc.ctc.edu