CPCC Registration Form
This is for juniors & seniors interested in getting a head start in college. Students will receive both college and
high school credit. To qualify, students must place in college level classes as determined by the CPCC
Accuplacter Test, or by scoring 500+ on each the critical reading and math sessions of the SAT, or 21+ on
each the English and Math sessions of the ACT. (Send official score report to CPCC).
Accuplacer/Study Guide/Tips: http://www.cpcc.edu/testing_assessment/placement-testing
Course Catalog: http://www.cpcc.edu/attending/catalog
Course Schedule: http://schedule.cpcc.edu/myschedule/
Social Security Number: _________________________ Cell Phone: _____________________________
CPCC ID Number: ______________________ Email Address: _________________________________
Name: _______________________________________________________________________________
Last
First
Middle
Fill-out below only if you have had a change of address:
Present Address: ________________________________________________________________________
City and State: ___________________________________________ Zip #: _________________________
CPCC Prefix & #
Section #
Course Name
Preferred Campus
Desired
Courses*
Alternatives
Student’s Signature: ___________________________________________________________________
Parent’s Signature:
___________________________________________________________________
Ms. Simmons Signature: ________________________________________________________________
For Central Office Use Only
Date Received: CMS_________________
CPCC ____________________