Community and Workforce Non-Credit Registration – River Valley Community College

Course - General Healthcare Pre-Apprenticeship CRN: 24009 Course #: 8084

GENERAL INFORMATION

Social Security (last 4 digits)(Required)

Birth Date(Required)

Name(Required)

First Middle Last

Former Name(s)

i.e. Maiden Name(s)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

(Please provide in the instance your class is cancelled or changed.)

Student Signature(Required)

Date(Required)

Signature - If student is under age 18, a parent or guardian is required to sign here.

Cancellation Policy

River Valley Community College reserves the right to cancel any course due to insufficient enrollment at least three days prior to the first session. RVCC makes every effort to notify students by phone and/or email as soon as the decision has been made to cancel a course.