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Part-Time Registration Form

This part-time registration form can be used for any term with open registration. Students will be contacted by e-mail concerning any pre-requisites, the availability, and the cost of their registration. Payment is due at the time of registration. For your convenience, we accept Visa or Mastercard over the phone.

Spring 2018 registration now open.

This form cannot be used for full-time registration. Degree seeking students may use Mustang WebAdvisor or visit Mustang Central after advising.

Please fill out all fields as completely as possible. Registration for courses requiring proof of a pre-requisite may be delayed until transcripts or assessment scores are received by WWCC. If there is a pre-requisite for a course, please e-mail a copy of unofficial transcript, degree audit, or placement scores to sheslep@westernwyoming.edu. This is required before registration can be completed.


Name and Demographic Information:
  (use legal name - no nicknames)
• First Name:
• Middle Name:
• Last Name:
• Social Security Number:   (format: 000-00-0000)
• Birth Date:
• E-Mail Address:
• Address (Street):   (include P.O. Box, if any)
• Address (City):
• Address (State):
• Address (County):
• Address (ZIP):
• Permanent Phone:   (format: 0000000000)
• If a Wyoming resident, how long
   have you lived in Wyoming?

Years
• Emergency Contact Name:
• Emergency Contact Phone:   (format: 0000000000)

The following questions are for reporting purposes only.
Students will not be identified individually in any reports.
• Gender:
• Ethnic Status: White
Black
American Indian
Hispanic
Hawaiian/Pacific Islander
Non-Resident Alien
Asian
• Marital Status:


Primary Reason for Enrollment:

Degree Seeking, With Transfer
      (planning to receive an Associate Degree and transfer to a 4-year institution)

Degree Seeking, No Transfer
      (planning to receive an Associate Degree and go to work in my field)

Certificate Seeking
      (planning to receive a certificate and go to work in my field)

Not Degree Seeking, Taking Courses for Transfer

Taking Courses to Develop New Job Skills Only

Upgrading Current Job Skills or Retraining

Personal Enrichment or Exploration

Teacher Recertification

Other (Specify):


Do you give WWCC permission to release your name, address, and
enrollment status as part of our directory information?


Course Information:
Semester of Registration:
• Course #1 Synonym Number:
• Course #1 Course Number:   (include section number)
• Course #1 Name:
• Course #1 Credit:
• Course #1 Time:
• Course #1 Days(s):
• Course #1 Instructor:
• Course #2 Synonym Number:
• Course #2 Course Number:   (include section number)
• Course #2 Name:
• Course #2 Credit:
• Course #2 Time:
• Course #2 Days(s):
• Course #2 Instructor:
• Course #3 Synonym Number:
• Course #3 Course Number:   (include section number)
• Course #3 Name:
• Course #3 Credit:
• Course #3 Time:
• Course #3 Days(s):
• Course #3 Instructor:

Questions or things we need to know about your registration:



Payment Options:

I will contact WWCC (307-382-1677) with credit card information.
      (MasterCard or Visa only)

I will mail a check or money order. Registration will be completed upon receipt.


Financial Commitment Statement:

I understand that once my registration is processed, I am officially registered for the semester and am responsible for all debts incurred. If my account is not paid in full, I understand that the College may hire a collection agency to take action. If my account is assigned to a collection agency, I understand that I am responsible for all attorney fees, court cost or delinquency fees that may be incurred during the collection of my debt. I understand that the delinquency fee will be equal to 50% of the principal amount owed. If a refund is due from my account, I authorize the College to automatically issue a refund check.

Note: Dropping and adding courses may adjust your student account or effect your financial aid. Contact Mustang Central at mustangcentral@westernwyoming.edu or by phone at 307-382-1677 or 800-226-1181.




I certify that this registration was completed by the student (me). Registrations completed by any other party constitute fraud. Submission of this application constitutes the student's signature on the registration.
 

For more information, contact Mustang Central at (307) 382-1677 or mustangcentral@westernwyoming.edu.
 
© 2017 WESTERN WYOMING COMMUNITY COLLEGE
2500 COLLEGE DRIVE, ROCK SPRINGS, WY 82901
(307) 382-1600 or toll free (800) 226-1181

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