WSCE logo Senior Citizen Application for Enrollment in Noncredit Courses
Workforce Services and Continuing Education
P. O. Box 80  Weyers Cave, VA 24486
(540) 234-9261/1-888-750-2722/ TDD 234-0848

Please complete the form, print, sign and return it to BRCC's Workforce Services and Continuing Education prior to requesting admission to a noncredit course.
See Senior Citizen Registration Policy.
Name
Social Security #
Address
City
State
Zip Code
Date of Birth
Phone Number

I hereby certify that I was at least sixty (60) years of age prior to the beginning of this class and I have been domiciled in Virginia for at least one year.

Signature
Date