Guest Student Course Request Form

Asterisk (*) indicates a response is required.

NOTE: First-time guest students and guest students out over a year must complete an application to the college. Please apply here

*I will be attending:
(please select one)

Clinton Community College
Muscatine Community College
Scott Community College
*I am enrolling in:
(please select one) Fall Winterim Spring Summer
*I am currently a student in good standing at : (Indicate your "home" college or university):

Be sure to speak with your advisor at your home institution to make sure you are taking courses that will transfer. EICC cannot guarantee the transferability of courses to your home institution.
*I am an International Student:

Yes No

If you are enrolling as a Guest International Student, please submit a copy of your VISA and I-20 to EICC. For additional information on Guest International Student status at EICC.
*First Name:
*Middle Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*Telephone Number:
Address at which you wish to receive registration confirmation:
(If different from above)
*Birthdate:
*E-mail:
*Status: New Guest Student (OR) Returning Guest Student

NOTE: Availability for certain courses, including Calculus and Physics, is limited. We cannot guarantee registration in courses. You will be notified by an advisor after submitting your guest registration request form if no seats are available in the course you have selected at the time your request is processed.

Class(es) in which you wish to enroll
Below is an example of a course listing and how the course information should be entered into the form. You can find the current class schedule here.

Example of a course listing

Below is an example of how to enter a course listing into the form.

Example of how to fill in the form

Section Number	Course Title	Dates/Times	Location (Online or College)	Credits	Instructors

* I understand that I am requesting to register for the above listed courses with Eastern Iowa Community Colleges. An advisor will review my course selection and approve my enrollment. Registration in the courses listed above is not guaranteed and is dependent on providing documentation verifying any course prerequisites are met, and also that there are available seats in the courses listed above at the time the advisor processes my request. The college will send me a confirmation of my enrollment once my course selection has been finalized. I will be enrolled as a non-degree seeking guest student with Eastern Iowa Community Colleges.

*Your submission of this form and acknowledgement serves as your electronic signature for this course request.

It is the policy of Eastern Iowa Community College District not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status, as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681-1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Debora J. Sullivan, Equal Employment Opportunity Officer/Equity Coordinator, Eastern Iowa Community College District, 101 West Third Street, Davenport, Iowa 52801, 563-336-3487, djsullivan@eicc.edu or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560 Facsimile: (312) 730- 1576, TDD (800) 877-8339 Email: OCR.Chicago@ed.gov.