Registration By Proxy Form printable pdf download

Registration by Proxy

In order to comply with federal laws dealing with confidentiality of official student records (Family Education Rights and Privacy Act of 1974),

the student must sign a release authorizing registration by proxy. The form below must be completed, signed and submitted at admission

and/or registration time. The student’s proxy must have this form signed by student along with the student's photo I.D. with

signature in order to receive registration materials. The student to be registered (not the proxy) has the ultimate

responsibility for paying tuition and fees.

•Complete an application for admissions. Documentation of residency will be required.

Step 1.

•Transfer students must submit transcripts from all previously attended colleges and universities.

This is State law and a policy of the DCCCD.

Admissions

•All students must have taken the required Texas Success Initiative (TSI) assessment test and the

Admissions/Student Records Office

computer literacy placement test or be TSI exempt before registering for any college level classes.

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•Proxy must have the completed Registration Proxy form signed by the student (below), a copy of

student’s photo ID with signature as well as the proxy’s proof of identification.

Step 2.

•Obtain Student Advising Report and a Registration Form before meeting with an advisor who will

Assessment Testing

complete the assessment referral for the student.

•If assessment testing is required, the advisor will provide an Assessment Referral form.

Admissions/Student Records Office

•Student must complete assessment testing requirement in person prior to registration.

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•A student Advising Report is required to register with an advisor.

Step 3.

•Transfer students must show proof of meeting specific course placement/prerequisite requirements.

Advising & Registration

Advisors will assist in determining eligibility for the courses based on official documentation provided

by the proxy.

Advising Center

•Please specify all course information for the class/es – class name, number, section, etc. In case desired

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course is not available, provide your registration proxy with course alternatives.

•The proxy should obtain the student’s Registration Summary before leaving the advising area.

Step 4.

•Make payment on or before payment due date printed on your Registration Summary.

•If payment is not made by the deadline, the student may be automatically dropped from all unpaid

Payment

credit classes. The student will be required to re-register with no guarantee that the original classes

Cashier Windows

will still be available.

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•The proxy will not be able to set up a tuition installment payment plan, but the student may do

this online.

REGISTRATION PROXY FORM

I hereby grant permission for the individual listed below to serve as my authorized representative for the purpose of my registration at Richland College.

This may include obtaining a copy of my Advising Report, selecting courses, adding or dropping courses, paying tuition, and signing advising and registration

documents on my behalf. The individual serving as my proxy may have access to any and all of my educational records. Copies of the student’s and proxy’s

photo IDs and signatures must be attached. This form may not be used to request and obtain official college transcripts, enrollment verifications or to

set up a tuition installment payment plan.

Print the following information:

Student’s Printed Name: _____________________________________________ Student ID#: _______________________________

Student’s Signature: ___________________________________________________________ Date: ___________________________

Semester/Year: ____________________________________________

Authorized Proxy’s Printed Name: ________________________________________________________________________________

Proxy’s relationship to Student: ___________________________________________________________________________________

Proxy’s Signature: ____________________________________________________________ Date: ____________________________

Registration By Proxy Form

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