New Member Application

Student Membership Form

CARTERET COMMUNITY COLLEGE
Corporate & Community Education


Please complete the membership form below. Required fields are marked with an asterisk.
STUDENT INFORMATION
*First Name:
*Last Name:
*E-mail Address:
*Telephone Number (include area code)Home: 252-222-6000
Telephone Number (include area code)Work:
*Street Address:
*City:
*State:
*Zip Code:
Please include your date of birth information below:
Month of Birth:Day of Birth:Year of Birth:
All students under 18 must complete a dual enrollment form to attend class.
Occupational students over 65-instructor must verify age in order to exempt tuition fee.
Sex: Male Female
Race: White Black Indian Hispanic Asian
Highest Grade Completed: or:(check below)
GED Diploma Adult High School 1 Year Voc Diploma
Associate Degree Bachelor's Degree Masters or higher
Residence: State: County:
Vocation:
Employment: Retired Full-Time Part-Time Unemployed
Employer: