Jenzabar University

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As of June 5th, all student email addresses (Microsoft accounts) now end with @student.qcc.edu (i.e. jsmith@student.qcc.edu).

Login to the Q and Blackboard prior to classes starting. The password remains the same.

No changes have been made to your Qmail accounts at this time.

If you cannot log in, contact the QCC IT Service Desk at 508-854-4427 or help@qcc.mass.edu.

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Jenzabar Contained Form

* Required

Undeclared Registration Request Form

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 ?

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

Race/Ethnicity-Select as many as apply

Race/Ethnicity-Select as many as apply

American Indian/Alaskan
Asian
Black/African American
White
Native Hawaiian or other Pacific Islander
Other

Are you Hispanic/Latino ?

Are you Hispanic/Latino ?

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

Are you a Permanent Resident ?

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

Valid Driver's license
Valid Car registration
Mass High School Diploma
Record of parents' residency for unemancipated person
Utility bills
Voter registration
Signed lease or rent receipt
Employment pay stub
State/Federal tax returns
Military home of record
Other

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

Choose a file

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:

Date

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