York County Community College &

Portsmouth Naval Shipyard

Registration form

Please take a moment to fill out this registration form. Doing so will allow us to collect the information necessary to build and maintain your YCCC student account. Please contact workforce@yccc.edu if you have any questions.

First Name

Last Name

Middle Name

Suffix

Preferred Name

Birth Date (mm/dd/yyyy)

SSN

Citizenship Information

Status

Resident Alien Registration #

Citizen Of

Additional Information

I identify as the following gender

Race (choose all that apply)

Ethnicity

Address Information

Do you reside outside of the United States?

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Country:

Contact Information

Home Phone Number:

Cell Phone Number:

If it's okay to text this number, please provide your cell phone carrier

Email:

Confirm Email:

Directory Exclusion

Unless a student withholds consent by use of an opt-out form, a college may disclose educational records without prior written consent under the FERPA exception for directory information. Directory Information is limited to a student's full name, email address, the fact that a student is or was enrolled, enrollment status, class level, majors/minors, dates of attendance, degrees, honors or rewards received, cumulative credit hours, and participation in recognized activities. If you check yes in the box below to exclude your directory information from being released, please be aware that this will also prevent your name from appearing in the local media for making the Dean’s List or President's list at the end of each semester. Do you wish to have your directory information excluded?

By submitting this form, I authorize York County Community College to enroll me in the courses necessary to complete the apprenticeship program as determined by the Portsmouth Naval Shipyard