Class Registration Form
Submit this form in person, to Cascadia Community College,
Enrollment Services Office at Rm. CC-103, 18345 Campus Way N.E.,
Bothell, Washington 98011-8205.
If you are not a U.S. Citizen, what is your immigration status?
Student VISA (F or M)
Visitor VISA
Permanent Resident
Refugee
Other
NOTE: Please attach copy of
the front and back of your
green card, or immigration
form I-94 or I-551.
How long have you lived continuously in
Washington state?
Years ________ Months ________
Were you financially independent from your parent or legal
guardian for the previous calendar year?
YES NO
If no, how long has your parent or guardian resided in Washington state?
Years
Months
Are you active duty military, spouse or
dependent child of same?
YES NO
YES NO
Are you a deceased veteran’s child?
What is your main long-term goal for attending
Cascadia Community College? (select one)
11 Taking courses related to current or future work
12 Transfer to a four-year college
13 High school or GED
14 Explore career direction
15 Personal Enrichment
90 Other ________________________________
COURSE
ABBREV.
COURSE
NUMBER
SECTION V/C
CREDITS OR
CLOCK HOURS
BUILDING & ROOM NUMBER
DAYS
M T W TH F S
HOURS
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
Sample 0 1 6 1 ENG 101 A 5 CC 110 x x x 8:45 - 10:50
Instructor Signature
INSTRUCTOR
USE ONLY
Overload
Permission
Expiration Date
if Required
I hereby certify under penalty of perjury under the laws of the state of Washington RCW 9a.72.085 that to the
best of my knowledge, all statements on this form are true and correct.
Student
Signature
TOTAL
CREDITS
Students who self-advise accept the responsibility for
completing all course requirements in their program of study.
Date
Advisor
Signature
Date
Refund Policy
Please see the quarterly class schedule for complete information.
BE SURE TO COMPLETE IMPORTANT
INFORMATION ON REVERSE SIDE.
SECTION