TVCC Distance Learning - Registration

Information Request form

eMail Address

First Name

Last Name

Last 4 digits of
Social Security

Street Address

City

State Zip

Home Phone

Cell Phone

Course Information

	Course Prefix Enter Course Prefix: (i.e. ENGL, HIST)	Course Number Enter Course Number: (i.e., 1301, 2411)	Section #	The name of the instructor and the college where the course originates.
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Please indicate that you have read and understand the new VCT reservation procedures by clicking the checkbox beside each statement.

I have read the new VCT reservation procedures and I understand that:

I cannot reserve a VCT space if Trinity Valley Community College is offering the same course online and space is available.

My reservation request will be honored only if the VCT course and instructor are approved and space is available.