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Student Registration Form

The following is a Registration Form for classes or events at the Successful Learning Center, Inc. If you are a returning student, please update the following information, select your classes and submit the form.

Has the student taken classes at the SLC before?
Permission to use photo

Student's Physical Information

The following is a request for information which will insure that each individual students' needs are met. Please indicate the status of any condition/s which will help us provide a successful experience. All information will be kept confidential.

Individual exhibits the appropriate behavior for a college campus.
Are there any factors which could hinder an individual’s ability to participate in the program/activities.

Responsibility

If Student is a minor (under legal age of consent) or is otherwise unable to legally consent to these Guidelines, for any reason whatsoever, you warrant that as the undersigned parent or guardian you have legal guardianship of Student and the capacity to bind yourself and Student to the terms of these Guidelines on Student's behalf.
​​The undersigned student, parent or guardian is responsible for the payment of the invoice generated by the SLC​ based on the submission of this registration form. Payments received later than the specified due date on the invoice are subject to an initial $25 late fee. Students with an outstanding balance will not be permitted to attend classes until their student account is clear. 
By registering, ("Student") for class ("Class") with Successful Learning Center ("SLC") at any participating SLC location ("Premises") you understand and agree to the following:

Student/Parent/Guardian acknowledges:

Monday

Spring 2025

50 Broadway, Hawthorne
Zoom

Tuesday

50 Broadway, Hawthorne
Zoom

Wednesday

50 Broadway, Hawthorne
Zoom
Rockland County - Dominican University

Thursday

50 Broadway, Hawthorne
Zoom

Pace University

#1041 Pop Culture, New World

#1148 Reuse, Reduce, Recycle

#2057 International History & Culture, Japan

#1085 World War II - Present

Friday

50 Broadway, Hawthorne
Discussions in the Gallery - 11 First Street, Warwick
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