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Coastline Military/Corporate Education PocketEd Registration


First Name
Last Name
Student ID
Email

STUDENT STATUS:
I AM A: New Student/Completed CCC Apply
Returning/Continuing Student
BRANCH OF SERVICE:
MILITARY STATUS:
Military Status*
If Active Military complete items A-D:
A. RANK
B. RATE/MOS
C. TA LOCATION
  If 'OTHER' please indicate:
D. YEARS OF SERVICE Completed  (not counting breaks in service)
DESIRED COURSES:
***NOTE: Additional documents and TA must be received no later than the 10th day of the month prior to the start of your program or you will not be enrolled.***
Course Start Date* Course Name*   Units  
   
     
     
*I understand that my registration form will not be processed until the college has received: Completed Proctor Form and TA Authorization and/or full payment.
TUITION RATE:
The tuition rate for the Mobile PocketEd program is $200 per credit/SH. Service members originally from or currently stationed in California may be eligible for a discounted tuition rate of $46 per credit/SH. For additional information on the tuition option for California residents, please visit: http://military.coastline.edu/page.cfm?LinkID=1634.
Students paying tuition out-of-pocket or who are authorized for less than 100% of tuition must submit the remaining balance by the registration/payment deadline. Payment may be made by credit card by completing and submitting the Personal Payment/Credit Card Authorization Form.
 

 
STUDENT POLICIES AND OBLIGATIONS*
  As a student in the Coastline Community College PocketEd program, I agree to adhere to the following:
(please read and check all)
1. I have read and understand the 'Steps to Register'.
2. It is my responsibility to adhere to all registration and course deadlines.
  1. All registration steps must be completed by the 10th day of the month prior to the registered course start date.
  2. Courses start the 1st of the month and end 12 weeks from the registered start date.
  3. In order to drop a course and receive a full refund, an Online PocketEd Drop Request form must be submitted within 9 days of the registered class start date.
3. For each 3 unit course, I should plan on devoting at least 9 hours per week to the coursework.
4. It is my responsibility to communicate with my proctor when I am ready to take course exams, to follow all rules for exam proctoring, and to adhere to the college’s Academic Honesty Policy. The Policy can be reviewed on the Coastline Military Website: http://military.coastline.edu, under Honesty Policy.
5. Before I take my final exam, I will submit my quiz Scantrons to my proctor.
6. I understand that it is my responsibility to purchase my course materials prior to the course start date, including textbook and course packet.
7. I understand that the course content is delivered on a standard size SD Card and I am responsible for providing a device that will support a standard size SD Card and operating systems as described under minimum requirements. I understand that I may contact CCCMobile@coastline.edu if I do not have a supporting device.
8. The SD Card and all its content shall always remain the property of Coastline Community College and I will return the SD Card after completing or dropping my course. I understand that if I do not return the SD Card, a hold will be placed on my account. This hold will prevent me from registering or requesting transcripts.
9. If I experience any difficulties while completing my PocketEd course, it is my responsibility to contact the school at CCCMobile@coastline.edu or (714) 241-6326 x16634.
AGREEMENT*
  Today's Date: 01/16/2019 02:53:06 PM
  THIS APPLICATION IS CONSIDERED A LEGAL DOCUMENT AND WILL BECOME A PERMANENT PART OF YOUR RECORD. FALSIFICATION OF THIS DOCUMENT MAY BE CAUSE FOR DISMISSAL AND OTHER LEGAL ACTION DEEMED APPROPRIATE. (please read and check all)
I CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT AND THAT I AM IN COMPLIANCE WITH THE REGISTRATION INSTRUCTIONS AS SET FORTH ABOVE.
  This institution does not discriminate on the basis of sex, is an equal opportunity institution, and complies with Title IX.
Coastline Community College cannot and will not release personally identifiable information about you to any outside individual, organization, or government agency unless specifically authorized by law, or by your consent. By submitting this document, you hereby authorize Coastline Community College to release your educational records to the United States Department of Defense or other Coastline Community College designee, under the provision of the Family Educational Rights and Privacy Act 1974, for the period of time while you are participating in the military education programs at Coastline Community College. Those organizations and agencies to which your information may be given are prohibited by law from using it for any unauthorized purpose or from subsequently releasing it to anyone else.
I authorize Coastline Community College to enroll me in the classes indicated above.
 

Thank you for choosing Coastline Community College.