STUDENT RECORD

Welcome to LVCC! Please complete the form below to register as a student.
For last name, please use your legal last name.

FILL OUT EVERY FIELD IN THE REGISTRATION FORM. YOU WILL GET AN ERROR MESSAGE IF FIELDS ARE NOT COMPLETED.
CLICK SEND ONCE YOUR FORM IS COMPLETED
THEN, SCROLL DOWN, FILL IN YOUR CREDIT CARD INFORMATION TO PROCESS YOUR PAYMENT, AND CLICK SUBMIT

There is a required one-time $25 non-refundable Registration fee.

Intake Date

First Name*

Middle Name

Last Name*

Birthdate*

Gender

Male

Female

Address Line 1*

Address Line 2

Zip Code*

City*

Country*

State

Home phone

Mobile phone*

Work phone

Email address*

Are you Hispanic/Latino?

Yes

Country of birth?

Race?

Highest Ed. Level Compl. on Entry:

Employment Status

Do you have barriers to employment?

Yes

Choose one or more if Yes:

Apparent or disclosed disability?

Yes

Specific disability

Don't leave yet! Please complete your payment below to finish your registration process.

This field should be left blank