FTCC CE Form - Vistelar College

Student ID or Social Security Number

Name of Course

Location of Instruction

1. Name

First Last

2. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

6. Email

7. Birthdate

8. Sex

Male
Female

9. Race

10, State of Residence

11. County of Residence

12. Highest Education Level

Enter Code For Highest Grade Complete: --- [01 to 11] Enter Highest Grade Completed --- [12] High School Graduate --- [HSE] HSE --- [13] Adult High School Diploma --- [14] Post High School Vocational Diploma --- [15] Associate Degree --- [16] Bachelor's Degree --- [17] Master's Degree or higher

13. Employment Status

Retired
Unemployed (not seeking)
Unemployed (seeking)
Employed (1-10 hrs. per week)
Employed (11-20 hrs. per week)
Employed (21-39 hrs. per week)
Employed (40 hrs. or more)

14. Home Phone

15. Work Phone

Cell Phone

16. Occupation

17. Employer

18. Citizenship

U US Citizen
E Eligible Legalized Alien
N Naturalized Citizen
A Non-Resident Alien

19. Military Status

Active
Inactive

Submission Date

Please Type Your Full Name

Vistelar College

Addressing The Entire Spectrum Of Human Conflict

Fayetteville Technical Community College

CONTINUING EDUCATION

STUDENT REGISTRATION DATA FORM