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WACC Student Registration

Student Information

Please be aware you must fill out a separate registration for each semester.

First Name*

Middle Initial

Last Name*

Student ID*

Street Address*

City*

State*

Zipcode*

SSN

Birthdate*

Phone Number*

Grade Level*

High School Email*

Term*

School*

Individual Identification

*Optional but recommended for reporting purposes

Ethnicity

Hispanic or of Hispanic heritage?

Gender

Emergency Contact Information

This information is only necessary if your emergency contract differs from your Parent / Guardian

Contact's First Name*

Contact's Last Name*

Relationship to Student*

Email*

Phone Number*

Course Information

Failure to properly indicate your course information may result in you not being registered.*

Semester*

Course(s)

A CRN	B Class Name	C Section

Add New Entry

Electronic Signature*

Submission Date*