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The College at Brockport Course Registration Form

WinterSession '15 Fax/Mail-in Registration begins
Monday, November 10, 2014.

WinterSession '15 Fax/Mail-in/In-Person Registration Deadline
is Friday, December 19, 2014 at 3 pm

Banner ID Number: ______________________________________________________

or Social Security Number: ________________________________________________

Last Name: _____________________________________________________________

First Name: ____________________________________ M.I. _____________________

Home Address: __________________________________________________________

City: _________________________________ State: ___________ Zip: _____________

Daytime Phone (including area code): _________________

Cell Phone: ______________________

Email 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.

Please call the Office of Registration and Records at (585) 395-2531 to confirm receipt of your form.

New-to-the College students must submit The College at Brockport New Student Information Form to the Office of Special Sessions & Programs before your registration can be processed.