Visiting Student Registration Form
for Act 48 Credit

Name:
Former/Maiden Name: 
Address: 
City: 
State: 
County: 
Zip Code: 
Date of Birth: 
Social Security Number: 
Gender:  Male  Female 
Telephone (day): 
Telephone (evening): 
Telephone (cell): 
Email address: 
Are you a US Citizen?  Yes  No
Country of Birth? 
Resident Alien Number:
Visa Status:
Occupation: 
Business Name: 
Business Address: 
Business Phone:
Employer Tuition Reimbursement Plan Yes  No
%paid minimum grade required:
If yes, payment is made before   after semester
How did you first hear about Cedar Crest College?
Please list your current certification:
I am registering for Courses for the : 

term

Course Number Course Title Credit/Audit
Credit
Audit
Credit
Audit
Credit
Audit