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Registration Form

Please print this web page on your printer and completely fill out all parts of the form below to register for Continuing Education Classes. You may fax your printed form to (201) 447-7861
 
Social Security Number
 
Last Name
 
First Name
 
Middle Initial
Street Address
Apt. #
City or Town
State
Zip Code
Country
Home Telephone with Area Code
Business Telephone with Area Code
E-mail Address
Federal Reporting
Both the State and Federal Government require that we submit information on our student's characteristics. Your response to this section is voluntary, but will help us to implement our affirmative action policy. BCC is an equal opportunity institution. This information does not affect admission or placement.
Have you ever taken a BCC Continuing Education Course? Yes or No
Sex  Male  Female
Race Education Reason Attending How did you hear
about the program?
Black, non-hispanic Less than high school Enrichment Friends
American Indian High School Certificate/CEU Previous Course
Asian or Pacific Islander College College Prep Work
Hispanic
Associate's Degree
 Update Skills Newspaper
Caucasian, non-hispanic Bachelor's Degree New Career Other
Non-resident alien Master's Degree Recreation
Other Doctorate Consumer
Education
Course #
Class #
Course Title
Start Date
Day (Circle)
Cost
M T W Th F S
M T W Th F S
M T W Th F S
M T W Th F S
Total
Visa/MC #
Exp. Date
Signature (as name appears on card)
Please make checks payable to BERGEN COMMUNITY COLLEGE

MAIL REGISTRATION FORM TO:
Bergen Community College Division of Continuing Education
400 Paramus Road
Paramus, NJ 07652-1595

NOTE: With this application you are registered. Unnless notified to the contrary, please report to your first scheduled class. NO CONFIRMATIONS WILL BE SENT.

REFUND POLICY:
The College reserves the right to change courses, days, times and instructors, and to withdraw courses without notice. A student who withdraws five working days before a class begins will receive a full refund. NO REFUNDS OR CREDITS WILL BE GIVEN THEREAFTER. Please allow 4-6 weeks for processing. All refund requests must be in writing. Note: Transfer credits are not eligible for a refund.