Community and Economic Development
Walters State Community College 

500 S. Davy Crockett Pkwy.

Morristown, Tennessee 37813-6899

REFUND POLICY: The college’s policy on refunds is that there will be no refunds other than for cancellation of the class. For extenuating circumstances this policy may be appealed through the Dean of Community and Economic Development to the President.
STUDENT INFORMATION (Information requested for person registering for the class)

Method of Payment
        Visa or Master Card ** (If Visa or Master Card please call 1-423-585-2675)
     Mail Check **Payment must be received seven (7) days prior to class.
     Bill Company ** Please list billing information below

COMPANY INFORMATION 
Name  
Address
CityStateZip
Purchase Requisition # Billing Contact (Attention)

STUDENT INFORMATION
Social Security NumberBirth Date
Name  (First Middle Last)
Address
City    State   Zip Code
Work PhoneHome Phone
FaxE-Mail
SexMale Female

CLASS INFORMATION
Course/Seminar Name
Course Location   
Time   
Date    
Day(s) 
Fee      

SELECTIVE SERVICE CERTIFICATION

Chapter 759 of the Public Acts of 1984 provides that no person who is required to register for the Federal Draft under 50 United States Code App. Section 453 shall be eligible to enroll in any state postsecondary school until such person has registered for such draft. Under Federal law the responsibility to register lies with any male citizen of the United States and every other male person
residing in the United States who was born in 1960 or later.

 I understand that failure to provide WSCC with my Selective Service number will result in me being administratively withdrawn from Walters State Community College with no credit or fee refund.