HACC Senior 65+ Program Application Form

1 downloads 193 Views 100KB Size Report
Jun 30, 2010 - instructor's attendance requirements may be dropped from the class. ... mastery of the material covered i
Senior 65+ Program HACC Gettysburg Campus 731 Old Harrisburg Road Gettysburg, PA 17325

HACC Lancaster Campus 1641 Old Philadelphia Pike Lancaster, PA 17602

HACC Harrisburg Campus One HACC Drive Harrisburg, PA 17110-2999

HACC Lebanon Campus 735 Cumberland Street Lebanon, PA 17042

HACC York Campus 2010 Pennsylvania Avenue York, PA 17404 HACC Virtual Campus One HACC Drive Harrisburg, PA 17110-2999

Conditions of Senior 65+ Program •

Must be 65 years of age or older.



Must be a permanent resident of Adams, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Mifflin, Perry, Schuylkill or York county.



All courses must be taken as audit only. Students auditing courses are expected to attend all lectures and laboratory classes but are not required to take examinations. Students who do not meet the instructor’s attendance requirements may be dropped from the class. The audit grade does not reflect mastery of the material covered in a course and no credit is awarded.



Course prerequisites and placement testing requirements must be met for each course.



Developmental, ESL, study abroad, and non-credit courses are all excluded.



The $35 application fee will be waived for new students admitted into the Senior 65+ Program.



In-person enrollment is permitted five business days prior to the start of part of term.



Tuition will be waived, but required fees are the responsibility of the student and payable at the time of enrollment.

To qualify for free tuition, each senior citizen must •

Complete a HACC Application for Admission - high school transcripts are not required.



Select the program major NDGR on the application for admission.



Provide proof of age and residency (driver’s license, birth certificate, tax receipts, etc.).

HACC Senior 65+ Program Application Form HACC ID Number:___________________________

Last Name:__________________________ First Name ______________________ M.I. ____ Address:_____________________________________________________________________ City:__________________________State:_______ Zip:_______________ Home/Day Phone:___________________________Cell Phone:________________________ E-mail Address:______________________________ Date of Birth:________________________________ Eligibility Requirements 1.Unless I am a current student, I have completed a HACC application for admission. ____Yes _____No (I am a current student) Note: All current students must change major to NDGR. 2. I am at least 65 years of age (proof required). ____Yes _____No 3. I am a resident of Dauphin, Cumberland, Perry, Lancaster, Lebanon, Mifflin, York, Adams, Franklin, Schuylkill, Fulton or Juniata County. ____Yes _____ No 4. I understand that I am permitted to audit credit classes and tuition will be waived; however, I am required to pay all other required fees at the time of registration and to purchase my own books. ____Yes ____No 5. I have met all required course prerequisites, including any required placement testing for the courses I plan to audit. ____Yes _____No 6. I understand that all developmental, ESL, study abroad and non-credit courses are excluded under the Senior 65+ Program. ____Yes ____No 7. I understand in-person registration is required five-business days prior to the start of part of term. ____Yes ____No

Name ___________________________________________________Date________________ Signature of HACC Representative____________________________________________Date________________

6/30/2010