Delta College
Experience the Delta Difference

DELTA COLLEGE
NON-CREDIT REGISTRATION FORM

MAIL TO: Registrar's Office, Delta College, 1961 Delta Rd., University Center, MI 48710
FAX TO: (989) 667-2221

CHECKS PAYABLE TO: Delta College
PAYMENT DUE DAY OF REGISTRATION

* required
DATE *
MM/DD/YYYY
SEMESTER: *
FALL
WINTER
SPRING/SUMMER
COUNTY OF RESIDENCE: *
BAY
MIDLAND

SAGINAW
OTHER
HOW LONG (MO/YR) *
DELTA ID # or SOCIAL SECURITY # *
LAST NAME *
FIRST NAME *
MIDDLE
STREET ADDRESS *
CITY *
STATE *
ZIP *
HOME PHONE *
BUSINESS (OR DAY) PHONE *
LAST YEAR ATTENDED DELTA (OR NEVER) *

 

COURSE NO.
COURSE TITLE
TIME
DAY(S)
CLASS BEGINS
TUITION/FEES
  TOTAL AMOUNT $

 

 

CHARGE MY : *
VISA
MASTERCARD
DISCOVER
CARD NUMBER: *
EXPIRATION DATE *
Security Code (3 digit code on the back of your credit card)*

 

Copyright © 2004 Delta College - Revised: August 6, 2007