ACC CONTINUING EDUCATION REGISTRATION
Date:__________
|
Last Name
First
Mailing Address
|
Date of Birth
City
|
Social Security Number/ID
State
Zip Code
Email Address
Home/Cell Phone #
Work Phone #
Name of Course
Start
Date
Course
Prefix
Course
Number
Synonym
Number
Section
Number
Campus
Tuition
Lab
Fees
Other
Fees
Sample 
Solar Electric Installation
01/28
HART
1071
89850
200
RVS
$475
$25
$3.50
Room
Numbers may
change and will
be posted the
first day of
class
Cardiac Drug Update
HPRX
3003
n/a
$20
n/a
n/a
Subtotal
ACC Parking Permit fee (needed for classes at ACC campuses that are over 30 hrs and 4 weeks long ) - $10.00 fee
ACC Parking permit valid from Sept 1 - Aug 31
Total Fees, Tuition & Parking (payment due at time of registration)
$ 20
Please Check One: (for State Reporting Purposes)
Ethnicity:
 Hispanic/Latino
 Black/African American
 Asian
 American Indian/Alaskan Native
 Native Hawaiian/Pacific Islander
 White
 Other
Gender:
 Female
 Male
Students with disabilities that need
accommodations should contact ACC’s Office for Students
with Disabilities at (512) 223-2026 or
TTY 512-223-2019 or visit www.austincc.edu/osd for more
information.
Family Education Rights and Privacy Act of 1974
The following statement concerning student records maintained by Austin Community College is published in compliance with the Family
Education Rights and Privacy Act of 1974. The release of information to the public without the consent of the student will be limited to
that designated as directory information. Directory information includes name, address, telephone number, date and place of birth, major
field of study, participation in activities, dates of attendance, degrees, certificates and awards, and name of most previous educational
institution attended. Any student objecting to the release of all or any portion of such information must notify the Office of Admissions in
writing and the restriction will remain in effect until revoked by the student.
No receipt will be mailed, please call if you need confirmation of your class registration.
Please note that Insurance Fees are non-refundable after first class day.
____________________________________________________________________________________________
Signature
Date
Payment is due at the time of registration. Please make payment with cash, check, or credit card at any of the ACC Campus Cashier offices within
24 hours after registering for courses. We currently accept Visa, MasterCard, American Express or Discover. Payment must be received within 24
hours to avoid being dropped from class.
Automated telephone registration: (512) 407-3087 or toll-free (866) 878-7889. Online registration: www.austincc.edu/ce/register
Mail-in payments will be accepted with completed registration form in the form of check or money order.
Austin Community College Continuing Education • Attn: CE • 5930 Middle Fiskville Road • Austin, TX 78752 • (512) 223-7542 • www.austincc.edu/ce
CE 09-08