Enrollment Confirmation
Congratulations on making an excellent decision!

You are only one step away from joining the Elmira College family. Complete the enrollment confirmation form below, hit submit and relax, your college search is over. The non-refundable enrollment deposit and orientation fee will be credited to your student account.

Student Information

*Student First Name
Student Middle Name
*Student Last Name
*Permanent Address
*City
*State
*Zip Code
*Phone Number
County of Residence
*Date Of Birth

Enrollment Information

*Are you a
*Intended Major
*Start Term
*I will be a
*Financial Aid Applicant

Billing Information
*Your Email Address
*Credit Card Type
*First Name (as it appears on the card)
*Last Name (as it appears on the card)
*Address
*City
*State
*Zip Code
Payment Amount
$175.00
*Credit Card Number
*Expiration Date
  /  
*CVV2 Code  (3-4 Digits)
     
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X  CVV2 Code





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