Course Registration Form
Contact Information

LastName:FirstName:M.I.
former Name:
Permanent Home Address:
City:State:Zip:
Home County (New York State Residents Only):
Please check here if your address has changed 
Home Phone:    Local Phone:
Complete Email Address (e.g. - student@server.com):
*REQUIRED

PLEASE MAKE SURE YOUR EMAIL ADDRESS IS CORRECT. REGISTRATIONS WITH INCORRECT EMAIL ADDRESSES WILL BE CANCELLED!

Student Information

Social Security#*###-##-#### (include dashes)
Today's Date:   Semester:
Current Major:
Have you ever previously attended MVCC? If Yes, Year:
Sex:   Date of Birth
Would you describe yourself as handicapped in a way that may require special accomodation at MVCC?Yes 

*Authority to solicit social security number has been established under sention 355 of the education law of the state of New York.

 Additional Information

Ethnic Identity* (Choose One):

*For state auditing purposes

Course Registration Information

 Select up to 5 course(s) you wish to enroll in:

Course #1
Course #2
Course #3
Course #4
Course #5

Charges:
Out of State - $142.50 per credit hour
In State - $95 per credit hour
(all above courses are 3 credit hours each, except HS104, which is 1/2 credit hour)
There may be additional fees. Please visit our Tuition and Fees Page for more information.

For Credit Card payment (If you do not wish to pay by credit card, you will be billed by mail):

Card Type:
Name Exactly as it appears on Card:
Card #: Expiration Date: 

By submitting this form, you signify your agreement to all terms, conditions and notices contained or referenced in the MVCC College Catalog, MVCC Student Handbook and Registration Booklets. If you do not agree to these conditions please do not use this site. MVCC reserves the right to update or revise these conditions. Your continued use of this site following the posting of any changes to the conditions constitutes acceptance of those changes.


Furthermore, I am agreeing to make payment for courses I registered on-line, to follow the MVCC procedures and guidelines of the college. I am responsible for dropping the courses and I am subject to the refunds established by MVCC.