CCSNH 100% Online Course Registration Form

What Makes a Successful Online Student?

Self Evaluation for Potential Online Students

You will be provided with a CCSNH email address to use in your online course.

Online Support Center 24/7 and the 100% Online Courses Schedule

Enrolling in an online course (registration):

In person: Preferred – go to Registrar’s Office at the campus offering the course.

Phone: Call the campus that is offering the course

Fax: Call the campus offering the course for the fax number

Mail: Mail this completed form to the campus offering the course (include

payment). Mail is the slowest method and may result in a course being fully enrolled by the time your registration form arrives at the college.

Circle your home college (if you are already enrolled in an academic program at one of these colleges):

Berlin Claremont Concord (NHTI) Laconia Manchester Nashua Stratham Not applicable

Circle the college that is offering the online course you want to take:

Berlin Claremont Concord (NHTI) Laconia Manchester Nashua Stratham

Social Security Number (SSN):

__ __ __ - __ __ - __ __ __ __

(3 #s) (2 #s) (4 #s)

Last name First name Middle name

Street address

City State Zip

Home phone Cell phone Work phone + extension

Your personal email address:

Payment:

You must pay for the course at the time you register in order to reserve a space in the course.

Students who complete and submit the official college withdrawal form to the Registrar’s office prior to the beginning of the second week (Monday) of the course will receive a 100% refund of tuition, less non-refundable fees such as advance tuition deposits, admission application fee, resident activity fee, residence hall room deposits and orientation fees.

Students who neglect to submit an official withdrawal form within the drop/add period above are not eligible for a refund.

Students who officially withdraw after the SUNDAY of the second week of the course will not be eligible for a refund.

I understand by registering for courses at the Community College System of NH, I am financially obligated for ALL costs related to the registered course(s). Upon a drop or withdrawal, I understand that I will be responsible for all charges as noted in the student catalog and handbook. I further understand that if I do not make payment in full, my account may be reported to the credit bureau and/or turned over to an outside collection agency. I also understand that I will be responsible for the costs of the outside collection agency, any legal fees, and any bounced check fees under RSA 6:11, which will add significant costs to my account balance.

Student’s Signature: Date:

Payment options:

Cash amount Money order Bank MO# Personal check Bank: Check#

Credit Card Type Number Expiration date

Scholarship (which one): Other financial aid:

Course name Catalog number CRN number

Berlin 2020 Riverside Drive Berlin, NH 03570 Tel: 800-445-4525, extension 1314 Fax: 603-752-6335 (Attention: Registrar)	Manchester 1066 Front Street Manchester, NH 03102-8518 Tel: 800-924-3445, extension 318 Fax: 603-668-2997 (Attention: Registrar)	Nashua 505 Amherst St Nashua NH 03061-2052 Tel: 603-882-6923, extension 1556 Fax: 603-882-8690 (Attention: Continuing Education)
Laconia 379 Belmont Road Laconia, NH 03246 Tel: 800-357-2992, extension 719 Fax: 603-524-8084 (Attention: Registrar)	Stratham/Portsmouth 277 Portsmouth Ave Stratham NH 03885-2297 Tel: 800-522-1194 option 2 or 603-775-1198 Fax: 603-772-1198 (Attention: Registrar)	Claremont 1 College Dr Claremont NH 03743 Tel: 800-837-0658 extension 316 or 317 Fax: 603-543-1844 (Attention: Registrar)
New Hampshire Technical Institute 31 College Drive Concord, NH 03301-7412 Tel: 603-271-7122 Fax: 603-223-0785 (Attention: Community Education)	Click here for driving directions to campuses

Revised 30Nov07 Rev2