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North Country Community College
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Center for Lifelong Learning
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Five-Hour Pre-Licensing Course
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Date of Birth
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Ex. Essex, Franklin
High School Name
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Have you ever enrolled for credit courses at NCCC?
Have you ever been dismissed from a college for disciplinary reasons?
Have you ever attended another college?
Name of college and degree earned if any.
Permanent U.S. Resident
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If "Other" please enter Country name.
Country of residence
For the next section, please enter Dept Code, Course Number, Section Letter, Days, Times, Building/Room and Credits (separated by a comma). Enter one line for each course you want to take.
Each entry for a course should look something like this:
ENG, 102, T, MW, 8am-9am, DL, 3
MAT, 105, T, MW, 10am-11am, DL, 3
SOC, 101, T, F, 9am-12pm, TI-102, 3
Enter course information here
Enter the total amount of credits registered for
I would like to pay online
I would like to pay by check-by-mail
I would like to make payment arrangements
If online payment or check-by-mail is chosen, you will receive an e-mail with instructions on how to proceed after submitting request.
I am the individual requesting to be registered for the courses listed above.
I understand, that by signing this registration form, I am formally registered for the above indicated semester and have incurred a financial obligation to pay for these courses unless I formally drop the courses in writing prior to the start of the semester. I understand I will need to obtain a Certificate of Residence from my home County Treasurer’s Office within 30 days of the start of classes to receive In State Tuition.
Enter your full name - Parent/guardian signature if registrant is under 18 years of age.
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Last Updated 6/5/23