WinterSession

The College at Brockport
Fax/Mail-in Course Registration Form

WinterSession '12 Fax/Mail-in Registration begins
Monday, November 7, 2011.

WinterSession '12 Fax/Mail-in Registration Deadline
is Friday, December 16, 2011 at 4 pm.

Social Security Number: ___________________________________________________

or Banner ID Number: _____________________________________________________

Last Name: _____________________________________________________________

First Name: ____________________________________ M.I. _____________________

Home Address: __________________________________________________________

City: _________________________________ State: ___________ Zip: _____________

Daytime Phone (including area code): _________________

Cell Phone: ______________________

E-mail Address: ____________________________________

List the course you would like to register for below:

CRN	Dept	Course # & Section #	Course Title	Credits

Fax completed form to the Office of Registration and Records at (585) 395-5392
or
Mail completed form to the Office of Registration and Records, The College at Brockport, 350 New Campus Drive, Brockport, NY, 14420-2966.

New-to-the College students must submit The College at Brockport New Student Information Form with the Course Registration Form.