REGISTRATION FORM

Learning opportunities are open to all college employees.

If the STARS touch-tone registration system, 410-777-2241, is not available, send this registration form to the Instructional Support Center, Johnson 207. Call ext. 2325 for assistance.

Course Number: _____________________________

Section Number  ____________  STARS Number: __________________

Name___________________________________

Social Security Number            ______  ____  ______

Home Address______________________________________________

City State ZIP______________________________________________

Date of Birth           ______  ______  ______ _

Evening Phone:

Day Phone:

Department and Office Location if applicable:

AACC Office Phone/ voicemail:

Please check appropriate boxes

v     I am aware of the prerequisites, if any, for the course(s) 5 YES  5 NO

I am 5 Male  5 Female

I am 5 Faculty   5 Staff