CNG State Certification Registration Form

STUDENTS:

(mm/dd/yyyy)
       
Please indicate which documentation of met prerequisite you are providing.

Prerequisite documentation: (You only need to choose one of the following)
 
1

 
Note: No certification will be issued until proof of the above prequisites are met.

(As it appears on the card)
(If different than above)

To withdrawal from a class, the student must contact Kristi Fields at 682-7894. A full refund will be given for withdrawal prior to the start of class. If you are registered but do not cancel and do not attend, no refund will be issued.

I HAVE READ AND UNDERSTAND THE REFUND POLICY AND MY RESPONSIBLILITES REGARDING THIS ENROLLMENT.

Cardholder Signature:


__________________________________________________________________

Please PRINT the registration form then submit by MAIL with payment information. You should send a check, money order, P.O. or completed credit card information on the form. You may also fax this form to (405) 682-7549 or email to kfields@occc.edu.