Corporate Training & Community Education
Registration Form
Date_____________________
Personal Information
Last Name: ________________________________________________ First Name: _____________________________________ MI: __________
Mailing Address: _________________________________________________________________________________________________________
City: ______________________________________________County: _________________________State: ____________ Zip: ________________
Home Phone: _______________________ Cell Phone: _______________________ E-mail Address: _____________________________________
STUDENT ID #______________________________________Date of Birth: _____________________________
Employer Information (If applicable)
Company Name: _________________________________________________________________________________________________________
Course Information
_____________________________________________________ How did you hear about this course? __________________________________
Course/Program Title
Registration Options
Mail:
9500 Old Greensboro Road
Box 270
Tuscaloosa, AL 35405
In Person:
Corporate Training & Community Education
9500 Old Greensboro Road
Tuscaloosa, AL 35405
Fax:
Phone:
205.391.5868
205.391.2386
Payment Options
Payment may be made by cash, check, or credit card through the Cashier’s Office on the Martin Campus. For your convenience, credit card
payments may be made via telephone by calling the Cashier’s Office at 205.391.5831. Checks and money orders should be made payable to SSCC.
Non-Credit Refund Policy-To withdraw from a class, a student must contact Corporate Training/Continuing Education at 205.391.2386. In order to
receive a refund; students must withdraw before the first day of class. A 95 percent refund will be given to those students who withdraw before the
deadline (100 percent minus a five percent administrative processing fee.) Failure to attend the program does not constitute cancellation. All
registrations will be refunded in full for class cancellations due to insufficient enrollment .
Print Name: _____________________________________ Signature: ________________________________________ Date: _________________
The Privacy Act of 1974
Shelton State Community College will not disclose any record which is contained in a system of records by any means of communication to any person, or to another
agency, except pursuant to a written request by, or with the prior written consent of, the individual to whom the record pertains.
Equal Employment in Education and Employment
It is the official policy of the Alabama Department of Postsecondary Education, including all postsecondary institutions under the control of the State Board of
Education, that no person in Alabama will, on the grounds of race, color, disability, sex, religion, creed, national origin, or age be excluded from participation in, be
denied the benefit of, or be subjected to discrimination under any program, activity, or employment.