HS VIRTUAL REALITY GAME A
REGISTRATION (ADD/DROP)
Enrollment Services
11605 132nd Avenue NE, Kirkland, WA 98034-8506
Check services online at http://www.lwtech.edu/studenttoolbox
All new students must complete reverse side of this form
PRINT CLEARLY  COMPLETE ALL UNSHADED AREAS  SIGN
Student ID Number (SID)*
SUM
WTR
FALL
SPR
For year 2017 _____
Last Name ( Family Name )
Did you attend LWTech before?
No
Yes, in year: _______
Day Phone
Evening Phone
(
(
)
First Name ( print clearly as many letters as fit)
)
Middle Initial (if any)
Address — Number & Street, Route & Box or P.O., or Apt #
E-mail address (print clearly)
State
Do you have a physical or mental impairment which substantially limits one or more major life activities, such as seeing,
hearing, speaking, walking, learning, working, etc?
Yes
No
Former Foster Youth may qualify for educational benefits and support services.
Please check here if you have been in Washington State foster care for at least one year since your 16th
birthday.
REQUESTED CLASS SCHEDULE (ADDS OR DROPS) Valid item numbers must be provided. See Class Schedule or go to http://www.lwtech.edu/studenttoolbox.
Circle A = Add
or D = Drop
A or D
Item No.
Example: 9565
9020
A or D
Course Department & Number
Example: ENGL&101
Credits – only
for variable credit
VR Game Workshop
with registration fee
A or D
July 5-27, 2017
Date of Birth (MM/DD/YYYY; for example 07/30/1980)
/
/
How will your course work relate to your current or future work? (Check one.)
 11 Gain skills for a new job or career
 12 Gain skills for my current job or career
 13 Improve skills for a career change
 14 Does not apply
 90 Other
What is your main long-term purpose for attending this college? (Check one.)





Additional $84 for supplies due
A or D
Zip Code
@
City
11
12
13
14
90
Take courses related to current or future work
Transfer to a 4-year college and earn a degree
High school diploma or GED
Explore career direction
Other
PAYMENT DEADLINE - When registering for courses you are obligated to pay the tuition and fees for those
A or D
classes on the first day of the quarter. Students are encouraged to pay at the time of registration or to enroll in the
A or D
receive the level of refunds outlined in the college’s refund policy. Students who enroll after the first day of the
A or D
received by the end of the 5th day of the quarter are subject to being dropped from classes. Unpaid
payment plan program. If you enroll in a payment plan you must withdraw by the scheduled refund dates to
quarter must pay tuition and fees at the time of registration. Students with tuition and fees that have not been
balances may be subject to collections and you may be responsible for any collection and legal fees.
Faculty or Advisor Signature
Student Signature
Date
Registration staff use only – initial and date
Agent of registrar
Date reg. form received ___________________
Printed name __________________________
*Your SID is a college-assigned number unrelated to your social security number (SSN). To comply with federal laws, we are required to ask for your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). We will use your SSN/ITIN to report Hope
Scholarship/Life Time tax credit, to administer state/federal financial aid, to verify enrollment, degree and academic transcript records, and to conduct institutional research. If you do not submit your SSN/ITIN, you will not be denied access to the college; however, you may be
subject to civil penalties (refer to Internal Revenue Service Treasury Regulation 1.6050S-1(e)(4)for more information). Pursuant to state law (RCW 28B.10.042) and federal law (Family Educational Rights and Privacy Act), the college will protect your SSN from unauthorized
use and/or disclosure. Your SSN will not be used as your SID. If you are a new student, an SID will be assigned to you. The college provides equal opportunity in education and does not discriminate on the basis of age, color, national origin, sex or disability. Registration
Form (rev 6-09-2015)
Please complete the sections below
SEX
In the Summer VR Game Workshop students are attending an
educational program in an adult environment. Some classes may expose
minors to educational material that contains nudity, strong language, or
depictions of violence. Students may be exposed to alternative view
points and material of an adult nature in college classes. By enrolling the
student, I give consent to the student’s full participation in all high
school, college courses, programs, and activities.
I understand that attendance at LWTech is by permission only on a
quarter-by-quarter basis and is conditioned upon the meeting of the
program deadlines, other LWTech requirements and satisfactory
academic performance. I recognize that registration for classes will be by
appointment and there is not guarantee that desired classes will be
available at the time of registration.
I acknowledge that I/my child am/is expected to conduct themselves in a
manner consistent with expectations of the college and is accountable
for knowing college and program policies and procedures, which affect
their enrollment. I accept the terms and conditions of this program, and
LWTech’s guidelines concerning student privacy rights, which means that
no information can be released without the student’s written permission
where appropriate. Finally I agree that my child will initiate
communication with faculty concerning academic performance and
behavior.
Male
Female
Summer VR Game students must accept all of the Policies and
Procedures outlined in the LWTech Student Handbook which includes a
student conduct code. It is the student’s responsibility to know what the
rules of conduct are. Handbooks are available in any Student Services
office or on the LWTech web page.
Student’s Initial
Summer VR Game students must behave and dress in a manner
that is appropriate for the college learning environment.
Student’s Initial
High school students must verify items below.
Summer VR Game students must have appropriate preparation for
chosen course as specified by course description. I certify:
1.)
I am at least 15-years-old
Student’s Signature
Parent’s Signature
Student’s Signature