Eastern Iowa Community College District
Registration and Online Ag-Transfer Agreement Form
PLEASE NOTE:
After you submit this form, please print out the next screen for a copy of this "Agreement Form" for your records.
All fields are required.
Date:
Name -
Last:
First:
Middle:
Address:
City:
State:
Zip Code:
Telephone Number:
(please include your area code)
Address at which you wish to receive registration confirmation,
(if different from above)
:
Birthdate:
E-mail Address:
Program of Study:
New Student
(or)
Returning Student
Class(es) in which you wish to enroll:
Catalog #
Course Name
Credits
AGS:109
Introduction to Animal Science
3
AGH:106
Introduction to Horticulture
3
AGA:270
Principles of Crop Production
3
College where transferring this credit to:
Name:
City:
State:
It is my understanding that upon the completion of the courses listed above at Clinton, Muscatine or
Scott Community College for the 2007 Fall term, my transcripts will be forwarded to the "College"
indicated above. I have the necessary course pre-requisites for these courses and understand the
transfer status of the course(s) that I plan to complete.
PLEASE NOTE: Submitting this application is considered the same as a written signature.
I accept the above statement:
Refunds
Students who withdraw from the class(es) and complete the necessary procedure will be entitled to a refund of tuition
according to the following schedule:
75% Refund - August 31st
50% Refund - September 10th
Students who are receiving financial assistance and completely withdraw are subject to the current refund policy
regarding the return of funds to the applicable programs.
Any changes made to your original schedule may affect your Promissory Note plan.
Contact the Business Office for details.
PLEASE NOTE:
After you submit this form, please print out the next screen for a copy of this "Agreement Form" for your records.
