ID#      

    Academic Year : (Select one) Fall Spring Summer Winterim

    Campus: Main Campus   Schuylkill Center   Educational Off-Site

    Name :     Check one: Mr. Mrs. Ms.

     Address: Street :   City:   State:   Zip Code:

    Home Telephone     Work Telephone/Current Employer:

    Email:

    Statistical Information for Federal Reports

     American Indian
     Alaskan Native
     Asian American
     Black                     
     Hispanic
     White
     Other (Specify)

    Religion:

    Date of Birth: / /

Important Information

Add/Drop - Students have one week after the first official class meeting to add or drop courses.

Withdrawal - Please consult the Academic Calendar via the College's website for specific details.

**Students withdrawing from a course are still responsible for all tuition charges**