231 Hwy 58 South
PO Box 188
Kinston, NC 28502-0188
Telephone:(252)527-6223
Fax: (252)233-6880

Continuing Education  
 
 Course Registration
I plan to enroll:                             Campus Semester    Year
PERSONAL INFORMATION
Social Security Number:
Last Name:
First Name:
Middle Name:
Sr., Jr., III:
Address:
City:
State:
Zip Code:
Home Telephone:
Work Telephone:
Email Address:
Gender: Male Female
Date Of Birth:
Ethnic Background:
Inmate? Yes No
EDUCATIONAL EXPERIENCE
Select highest grade completed or choose answer:
EMPLOYMENT STATUS
Vocation
Employment
Employer:
RESIDENCY
Do you claim to have been a legal resident of the state of North Carolina for a period of at least twelve months immediately prior to the date of this application? YesNo
If yes, which county?
If no, where are you a legal resident?
When did you move to North Carolina? (Mo/Day/Year)
Citizenship? U.S. Citizen Eligible Legal Alien Naturalized Nonresident Alien
Certification of Accuracy

Please check: By this check I certify that the information I have given is true and complete to the best of my knowledge. I further understand that falsification or failure to supply the correct information may be considered grounds for rejection or dismissal. Further, I understand that by submitting this information via electronic transmission that I acknowledge the above statement of certification in lieu of a signature.
COURSE INFORMATION
This form is for the use of continuing education students only. Students who are enrolled for classes on campus should see their advisor to register. Registrations can only be accepted during the scheduled registration periods.
Course Title and Date
When the College receives your properly completed form, we will pre-register you for the Course Title you have selected in the space provided. You will be contacted by phone within 1 week to confirm your registration and answer any questions regarding payment options or general information you may need. You may contact us via the following phone numbers: Lenoir Main Campus in Kinston, (252) 527-6223, ext. 709 or 722, in Jones County at (252) 448-5021, or in Greene County at (252) 747-3434.

LENOIR COMMUNITY COLLEGE IS AN EQUAL OPPORTUNITY EDUCATIONAL INSTITUTION AND ENSURES THAT EQUAL OPPORTUNITIES EXIST FOR ALL MEMBERS OF THE COLLEGE COMMUNITY REGARDLESS OF RACE, COLOR, GENDER, DISABILITY, AGE, NATIONAL ORIGIN, POLITICAL AFFILIATION OR BELIEF.



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