North Harris College-Parkway Center
Date
:_____________________ Semester:_______________Name
:____________________________________________________________Address
:__________________________________________________________City/State/Zip
:_____________________________________________________Phone
:_________________ __________________ ______________________(Home) (Work) (Pager)
SSN
: ______________________Student Classification
: (check all that apply)_____
Freshman _____Sophmore _____Post Graduate_____Full-time _____Part-time _____Day class
_____Night classes
*Fees are $5.00 each semester.
UHA does not discriminate anyone of memebership regarding race, color, religion, national origin, sex, age, or disability.