PO Box 266 Dublin, NC 28332 Telephone 910.879.5539 Fax 910.879.5569 COURSE TITLE SECTION NO Day START DATE Evening SSN/BCC NO LAST FIRST MI MAILING ADDRESS DATE OF BIRTH CITY STATE ZIP HOME PHONE CELL COUNTY E-MAIL ADDRESS White Hispanic Native American Female Male Black Asian Other EDUCATIONAL LEVEL Employed Unemployed Non Graduate 1-10 hours Seeking Have you ever attend classes at (Enter highest grade completed 11-20 Not Seeking Bladen Community College? 21-39 Retired Yes No High School Graduate 40 or more HSE Diploma TUITION REFUND POLICY (High School Equivalency) Adult High School Diploma Refunds are allowed under the following circumstances: Vocational Diploma A student who officially withdraws, in writing, in person, from a class Associate Degree prior to the first day of class in person or if a class is cancelled shall be Bachelor’s Degree eligible for a 100% refund. Master’s Degree or Higher Registration fees for self-supporting classes are non-refundable once the HEAD OF HOUSEHOLD class begins. Yes No Our Community Service courses have been designed to help Ask about our fun Community Service courses. encourage lifelong learning by providing you with a means to express your creative, cultural, and leisure interests. These courses are self-supporting and no fee exemptions apply. The Community Service Department has something for everyone. Here is a list of some fun courses we offer: Shag Lessons, Cake Decorating, Floral Arranging, Paint Night classes, Wreath Making, Make your own Quilt, Photography, Event planning, Couponing 101, Crocheting, Let’s get crafty, Line Dancing, Ballroom Dancing, Guitar Lessons, Piano Lessons, etc. STUDENT SIGNATURE DATE If your check is dishonored or returned for any reason, we will electronically debit your account for the amount of the check plus a processing fee. Method of Payment $ Course Fees Cash Credit Card Check: $ Total Collected Third Party Billing Person Receiving Payment Receipt No.
PO Box 266 Dublin, NC 28332 Telephone 910.879.5539 Fax 910.879.5569 COURSE TITLE Day Evening SECTION NO START DATE SSN/BCC NO LAST FIRST MI MAILING ADDRESS DATE OF BIRTH CITY STATE ZIP HOME PHONE CELL COUNTY E-MAIL ADDRESS Female Male White Black Hispanic Asian Native American Other EDUCATIONAL LEVEL Non Graduate (Enter highest grade completed High School Graduate HSE Diploma (High School Equivalency) Adult High School Diploma Vocational Diploma Associate Degree Bachelor’s Degree Master’s Degree or Higher HEAD OF HOUSEHOLD Yes No Employed 1-10 hours 11-20 21-39 40 or more Unemployed Seeking Not Seeking Retired Have you ever attend classes at Bladen Community College? Yes No TUITION REFUND POLICY Refunds are allowed under the following circumstances: A student who officially withdraws, in writing, in person, from a class prior to the first day of class in person or if a class is cancelled shall be eligible for a 100% refund. Registration fees for self-supporting classes are non-refundable once the class begins. Ask about our fun Community Service courses. Our Community Service courses have been designed to help encourage lifelong learning by providing you with a means to express your creative, cultural, and leisure interests. These courses are self-supporting and no fee exemptions apply. The Community Service Department has something for everyone. Here is a list of some fun courses we offer: Shag Lessons, Cake Decorating, Floral Arranging, Paint Night classes, Wreath Making, Make your own Quilt, Photography, Event planning, Couponing 101, Crocheting, Let’s get crafty, Line Dancing, Ballroom Dancing, Guitar Lessons, Piano Lessons, etc. STUDENT SIGNATURE If your check is dishonored or returned for any reason, we will electronically debit your account for the amount of the check plus a processing fee. DATE Method of Payment $ Course Fees Cash Credit Card Check: $ Total Collected Third Party Billing Person Receiving Payment Receipt No.
Community-Service-Registration-Form.docx