PCCC Registration Request Form for Online Courses
Enrollment in classes is subject to availability and not guaranteed.

Important! This form should NOT be used to request information about online classes. Submission of this form will result in registration for all classes requested (if available) and financial responsibility for all relevant tuition and fees for those classes.

Note: Courses originally offered which have been filled and closed to further registration do not appear in the drop down list of courses below.

Students requesting registration into a Writing Intensive course section should first have completed EN-101 (Composition I) with a grade of C or better first.

Please refer to the Academic Bulletin to make sure you have fulfilled any prerequisites for the courses you are requesting.

Alumni: Please do not submit a request for registration form unless you are willing to pay full tuition.  If you want a class for free as part of your alumni benefits, please only submit a form on or after Waiver Day.

Fields followed by asterisks are required fields.

Your Email Address *
Confirm Your E-mail Address *
Last 6 digits of SSN or student ID # *
First Name *
Last Name *
Date of Birth *	XX-XX-XXXX - Month-Day-Year
Semester *	Spring (12 Week Semester)
Year *	2012
Course 1 *	BS-103 OL1 Anatomy & Physiology I (4 credits) *BS-104 OL1 Anatomy & Physiology II (4 credits) *BS-205 OL1 Physiology of Disease (3 credits) *COL-102 OL1 College Experience (1 credit) CT-101 OL1 Critical Thinking (3 credits)EN-101 OL1 Composition I (3 credits) EN-108 OL1 Creative Writing (3 credits) SC-104 OL1 Environmental Science (4 credits) * Hold the Ctrl key down to select more than one course. Courses with an MHY1 designation are hybrid courses Some courses are designated as Writing Intensive
Street Address *
City *
State *
Zip *
County
Ethnicity	American IndianBlack, Non-HispanicHispanic White Non-Hispanic Asian/Pacific IslanderOtherNot Reported
Gender	FemaleMale
Student Status *	Returning StudentNew StudentTransfer StudentVisiting StudentCollege Graduate
Degree Status *	MatriculatedUnmatriculatedDon't Know
Have you taken the PCCC Basic Skills Test?	Yes   No
Major
Phone
Comments	Please note: Submission of this form does not guarantee registration in the selected course. Confirmation of registration is usually sent out within 24 - 48 hours of submission, but may take longer during peak registration times.