First Name(*)

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Last Name(*)

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Banner ID:(*)

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Contact Phone Number:(*)

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College Email(*)

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City/Town Residence:(*)

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Age:

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Gender:

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Race:

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Ethnicity:

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Did You Apply For Financial Aid?(*)

YesNo Invalid Input

If you did not apply for financial aid assistance, Explain why?

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Are you receiving Financial Aid (FAFSA, Pell Grant, HCC Grant)?(*)

YesNo Invalid Input

If yes, does your funding cover 100% of your tuition? Please choose Yes or No:

YesNo Invalid Input

If you are not receiving funding or your funding does not cover 100% of your tuition, explain why not.

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I am in good academic and financial standing at HCC(*)

YesNo Invalid Input

Book Choices

Advanced ManufacturingAllied HealthBusinessInformation Technology Invalid Input

Mathematics for Machine Technology 8th AdditionMachine Trades Print Reading Precision Machining Technology Invalid Input

Medical Terminology - Medical Language: 3rd editionHuman Anatomy & Biology - Human Biology: Concepts & Current IssuesICD-10 Diagnosis Coding & HCPCS - (1) ICD-10-CM ExpertICD-10 Diagnosis Coding & HCPCS - (2) HCPCS Level II ExpertMedical Coding CPT - AMA CPT ProfessionalTEAS Exam Prep - ATI TEAS Study Manual Invalid Input

Real Estate Principles & Practices - (1) Modern Real Estate PracticeReal Estate Principles & Practices - (2) CT Real Estate Practice & LawBookkeeping Practices - Mastering Double Entry BookkeepingMastering Correcting and Adjusting Entries - (1) Mastering Adjusting EntriesMastering Correcting and Adjusting Entries - (2) Mastering Correction of Accounting ErrorsMastering Depreciation and Payroll - (1) Mastering DepreciationMastering Depreciation and Payroll -(2) Mastering PayrollMastering Inventory, Internal Controls & Fraud Prevention - (1) Mastering Internal Controls & Fraud PreventionMastering Inventory, Internal Controls & Fraud Prevention - (2) Mastering Inventory Invalid Input

QuickBooks - QuickBooks Desktop Level 1 Invalid Input

I understand That I will not mark up the book(s) lent to me with any writing or any other instruments.(*)

YesNo Invalid Input

I understand that I am required to return the book(s) to Continuing Education within 1 week of that last day of my class.(*)

YesNo Invalid Input

I understand that If I do not return the book within 1 week, the cost of the book(s) will be added to my final college bill.(*)

YesNo Invalid Input

I understand all the information above and agree that it is true.(*)

YesNo Invalid Input

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