NON-CREDIT Registration Form

NON-CREDIT Registration Form

This form may be duplicated  One form per person  NO registration will be accepted by phone.
This form is used for . . .
NON-CREDIT CLASSES: Registration for Non-Credit classes will be accepted ONLY if you have previously attended VVC.
NEW STUDENTS:
A new student must apply for Admission before registration will be accepted.
This form is not used for credit classes. No credit class registration will be accepted.
1. Complete information must be on registration
form and return by mail, or in person, at lease oneweek prior to semester start date. All information
must be complete or registration WILL NOT be
accepted.
2. Mail completed form to:
Admissions and Records Office
Victor Valley College
18422 Bear Valley Road
Victorville, CA 92395-5850 OR. . .
3. Register in person at Victor Valley College
Admissions and Records Office in
Student Services 1, Building 52.
USE THIS FORM FOR
NON-CREDIT REGISTRATION ONLY
Mail to: Victor Valley College
Admissions and Records Office
18422 Bear Valley Road
Victorville, CA 92395-5850
PLEASE PRINT CLEARLY
Last Name
First
________________
Middle
Day Phone
 Female
Male
________________
Evening Phone
________________________________________________________________________________________________
Mailing Address
City
State
Predominant Ethnic Background
 10 White Non-Hispanic
 28 Laotian
 28 Cambodian
 27 Vietnamese
 21 Chinese
 28 Other Asian
 22 Filipino
 26 Pacific Islander
 23 Indian subcontinent
(Tahiti, Fiji, Marshall I)
 24 Japanese
 26 Hawaiian
 25 Korean
 26 Samoan
Section #
Course Name
Starting
Date
Fee
ASB Fee _________
_____________________________________________
Student Signature
Date
 Check/Money Order  VISA/MC Discover 
_______________________
Shading denotes evening classes.
Zip
 26 Guamanian
 30 Black, Non-Hispanic
 42 Mexican, Mexican-
 44 South American
 50 Middle Eastern (e.g.
American
 41 Cuban
 43 Puerto Rican
 44 Other Hispanic
 44 Central American
 60 American Indian/
Instructor
Registration Fee $_________
Parking Fee
$_________
TOTAL Amt. Enc. $_________
CLASSES
__________________________________________________________
Sex:
Arabian, Iranian)
Alaska Native
 70 Other Non-White
 99 Unknown

 Check appropriate box for
following: have you been in
continuous residence in the State of
California for more than one year:
 Yes  No
Date residence began in California
____________________________
Month/Day/Year
FOR OFFICE USE CE ____ CS ____
Received by _____________________
Date ___________________________
CK _____ NO. __________________
Amer Ex Credit Card No. _________________________ Exp. Date _______
NON CREDIT
Social Security Number ________________________
Birthdate: Mo/Day/Year