Jenzabar University

Full Name (first, middle initial, and last):

Date of Birth (month, day, and year--01/01/2020):

State Identification Number:

High School students attending a Maine public High school can get this 9-digit number from guidance/aspirations.

All home schooled students use 999999999.

Students from private high schools OR students earning their HiSET/GED/Adult Diploma, please leave blank.

Email Address:

Cell Phone Number:

Home Phone:

If you listed a cell phone, who is your carrier? 

If you listed a cell phone, may we text you information regarding your course and WCCC?

Street Number and Address:

City, State, and Zip Code:

Are you a United States Citizen?: 

What high school/homeschool did you attend?

What year did you graduate high from high school?

Course(s): (Please list the course(s) number and name. For example, ENG 101- English Composition)

Have you taken a dual or concurrent enrollment at WCCC before?

By placing my initials in this box, I understand that I am/will:

• registering for a summer college course at Washington County Community College (WCCC);
• responsible for purchasing the course book; 
• contact WCCC, Donna Geel at dgeel@wccc.me.edu, if I decide to drop the course prior to the start; and 
• contact WCCC prior to the end of the add/drop deadline. If I do not contact WCCC prior to the end of the add/drop deadline, a W (withdraw) will be placed on my official WCCC transcript. 

Demographic Information: The following information is voluntary and not required to enroll in a Washington County Community College course. We collect the information for reporting purposes only. 

Gender:

Ethnic Group:

Race (select all that apply):