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) CCC MCC SCC
*I am enrolling in:
(please select one) Fall Winterim Spring Summer
*I am currently a student in good standing at:
*If you selected other, please indicate your college of attendance:
*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

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 an ONLINE course listing into the form.

Example of how to fill in the form

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

Example of how to fill in the form

Section Name & Title	Location or Online	Meeting Information (Course Dates/Times)	Credits

* 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. 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, Citigroup Center, 500 West Madison Street, Suite 1475, Chicago, Illinois 60661-7204, phone number 312-730-1560, fax 312-730-1576, OCR.Chicago@ed.gov.