Non-Credit Enrollment Form

Non-Credit

Student Registration Card

Note: Before completing this form, you must be a current student or submit a Older Adult Non-credit Application for Admission.

Please complete the following information:

FormTitle*

Student Name*

First Name

Initial (optional)

Last Name

Birthdate*

SRJC Student ID Number (SID)

Provide if known. Numbers only. No dashes.

Email

Phone

Semester*

Semester Year*

Example: 2020

Course Number*

Example: OA 501

Section number*

Example : 8100

Instructor Name*

First Name

Last Name

By providing your signature, you authorize Santa Rosa Junior College to enroll you in the course you have indicated on this form.*

Use your mouse or finger to draw your signature above