Jenzabar University

***QCC has instituted a mandatory vaccinations policy. Students must be vaccinated to attend in-person classes, unless they have received an approved accommodation. Please visit Medicat to upload your vaccination card if you have not previously done so. Vaccination cards must be received within 3 day of registration or your course registration  will be dropped. Please click here for detailed instructions on how to upload your vaccination card. To learn more about QCC’s vaccination policy  please visit, HealthySafeCampus. 

Note: This form is only for students not seeking a degree from Quinsigamond Community College. Complete the form, then click the Submit button. You will receive an email to the email address provided when your registration request has been processed. All fields with * must be completed.  

SSN# or QCC ID#

Prefix

First

Middle

Last

Suffix

Address 1

Address 2

City

State

ZIP code

Home Phone

Cell Phone

Date of Birth

Email Address

Sex

Are you a veteran of the U.S. Armed Forces ?

Race/Ethnicity-Select as many as apply

Are you Hispanic/Latino ?

Are you a United States citizen ? If yes, go to section DOCUMENTATION.

Are you a Permanent Resident ?

If yes, list Alien Registration Number

If you are not a U.S. Citizen or Permanent Resident, please state your Visa or immigration status in detail including Home Country.

Please check-off those documents you possess as proof of your intent to remain in Massachusetts

B. I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts

C. I am not a Massachusetts resident. My home state is :

What Semester are you registering for

Course Code

Section #

Course Title

   Credits

   Course Code

   Section #

    Course Title

   Credits

Course Code

   Section #

   Course Title

   Credits

Course Code

  Section #

   Course Title

   Credits

Prerequisites will be strictly adhered to. If you have taken the required prerequisite course(s) at another institution for the above selection(s), please UPLOAD a copy of unofficial transcript.

If you have not completed a college level English and/or mathematics course at another regionally accredited college and would like to register for English and mathematics courses or for courses requiring a prerequisite of English or mathematics please submit this form and an advisor will assist with your course registration. We are currently using Multiple Measures to help place students. Please visit our Assessment for Course Placement page for details.

I certify that this information is true and accurate. I understand that any misrepresentation, omission or incorrect information shall be cause for disciplinary action up to dismissal, with no right of appeal or to a tuition refund.

Type in your First and Last Name as an electronic signature
 

Date:

Parent/Guardian Signature (Student is under 18 years old)