Colleges of the Dallas County Community College District 11-18-16
Brookhaven College
registrar-bhc@dcccd.edu
phone: 972-860-4883
fax: 972-860-4886
Cedar Valley College
registrar-cvc@dcccd.edu
phone: 972-860-0805
fax: 972-860-8001
Eastfield College
registrar-efc@dcccd.edu
phone: 972-860-8357
fax: 972-860-8306
El Centro College
registrar-ecc@dcccd.edu
phone: 214-860-2311
fax: 214-860-2233
Mountain View College
registrar-mvc@dcccd.edu
phone: 214-860-8600
fax: 972-698-3074
North Lake College
registrar-nlc@dcccd.edu
phone: 972-273-3183
fax: 972-273-3112
Richland College
registrar-rlc@dcccd.edu
phone: 972-238-6948
fax: 972-238-6346
100% DISTANCE EDUCATION
AFFIDAVIT
LAST NAME: ______________________________ FIRST NAME: ______________________ MI: ______
STUDENT ID#: _______________ _____________ SEMESTER/YEAR: ___________________________
STUDENT EMAIL ADDRESS: _________________________________________________ _____________
The Dallas County Community College District requires that all new and returning students (those
who have had a break in enrollment of one semester or more) under the age of 22 show proof that
they have been vaccinated against bacterial meningitis.
By signing this document, you are stating that you have no intention of physically accessing a
DCCCD campus or property, and that you will remain in online courses for the rest of the time you
are enrolled.
You are also stating that if there are any changes that require you to go to a DCCCD campus or
property, you will follow the requirements set by the state and submit proof of the bacterial
meningitis vaccination (vaccination or booster shot needs to be within the last five years).
My signature below indicates that I am agreeing to the following conditions:
I am enrolled only in online courses with the Dallas County Community College District. I will not
physically access a DCCCD campus or property. If there are any changes that require that I go to
a DCCCD campus or property, I will follow the meningitis vaccination requirements and submit all
documents to the Office of the Registrar before I am allowed to register for my classes.
Student signature: ______________________________________ Date: __________________
Parent/Guardian signature if student is under the age of 18: _______________________Date: ______
Complete this form, fax or email it to one of the colleges** listed above.
Phone numbers have been provided if you have any questions.
**Distance Learning Students can also contact: Dallas Colleges Online, registrar-dtc@dcccd.edu
,
phone: 972-669-6400, fax: 972-669-6409
