TYLER JUNIOR COLLEGE
P.O.BOX 9020
TYLER, TEXAS 75711-9020		 Registration Form
Continuing Education
(Non-credit courses)

Registration Information
Please help us process your registration as quickly as possible by completing all blanks.

PLEASE NOTE: By completing this form, you have requested a seat in a continuing education class. Completion of this online registration form does not guarantee you a seat in this class. Online registrations are processed within 24-48 hours of receipt (except on weekends and designated holidays when the processing time will be longer). Once your registration form has been processed, you will receive a schedule and payment receipt in the mail, which indicates your seat in the class is secured. Prior to that time, you may call Bill Powell, Monday through Friday, at 903-510-2900 after 1:00pm if you have any questions.

If you need to register immediately for a class and guarantee your seat, you should call our registration line at 903-510-2900 and we will be happy to register you over the phone.
Registration Information
 Please help us process your registration as quickly as possible by completing all blanks.

Tuition/Fee    
Course Title  
Student No. (SSN#)     ( Numbers without dashes Example: 123456789)
Course & Section No.   (Example: ABCDXXXX XXX053Q)
Phone # (home)  
Phone # (work)  
Ext.
First Name   M.I.   Last Name 
Street Address   
Apt. No.   
City   
State     
Zip Code
County  
Email

 

Confidential Information All students are asked to complete this confidential information form. The information will be used for future planning of services which will benefit programs through equipment purchases and supplies provided by a Carl D. Perkins Federal Grant.

 
Birth Date
 
 
( Numbers without dashes )
Example: 05221978
Gender
Male
 Female
U.S. Citizen
Yes
 No
 Ethnic Group:
(1) Caucasian/White
(2) Black
(3) Hispanic
(4) Oriental-Asian
(5) American Indian
(6) Non-Resident Alien
First informed of
this course through:
 
Continuing Education Catalog
Newspaper Ad
Returning Student
Radio Ad
TJC Website
Television Ad
Magazine Ad
Other:
Do you have a Physical Disability?
Did you not graduate from high school?
 Is English your second language?
 Have you been unemployed or laid off during the last year?
 Are you a single parent with custody of a minor child?
Are you a home maker primarily working at home needing to upgrade our job skills?
 Do you have a Learning Disability?
 Did you receive a GED?
 Senior Citizen?
Are you receiving any financial assistance such as: TRC, CFB, Pell Grant, ETI/JTPA, Scholarships, Grants, etc?

Credit Card Information

 

 

#  

Month Year          


 
Refund Policy Information
Refunds may be requested at the registrar's office on campus or at the RTDC.   The College refund policy is: 100 percent prior to the first day of class or if the College cancels the class.  Eighty percent during the first class day and none thereafter.  Refunds will be mailed to the student's permanent address 2-4 weeks after classes are dropped.
 
Tyler Junior College gives equal consideration to all applicants for admission, employment and participation in its programs and activities without regard to race, creed, color, national origin, gender, age, marital status, disability or veteran status.