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PLEASE READ CAREFULLY BEFORE PROCEEDING: The following information is required to become a career credit student. The profile must be unique to the applicant and a unique email account is required to create a profile and register for a class. Your email becomes your username, and all course information and confirmations will be sent to this email. If you do not have an email, please contact our office at 276.656.0260 for assistance. Enter your full legal name, as it appears on your current legal documents such as driver's license or social security card. Name provided will appear on transcript, certification, and licensure documents. Not entering your social security number may incur significant delays in financial assistance and refund processes. Parents registering a minor for a class/camp: use name and information for the child when creating the profile and enter parent/guardian's daytime phone number. 
* denotes required information.
If you have previously attended, applied for admission to, or been employed by any Virginia community college, please enter your Student ID (EmplID) number if known. This is not required, but would be your 7-digit SIS EmplID.
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You will use your email address as your username on this site.
 Privacy Policy
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Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)
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Mail preference
May we include you on our mailing lists?
Yes No
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Birthdate*

Enter as mm/dd/yyyy format.
With what gender do you identify?
Man
Woman
Non-Binary
None of the above
Prefer not to answer
Are you Hispanic or Latino/a?

Defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
What is your racial or ethnic identification?

Providing the information below is voluntary. This question complies with the U.S. Department of Education’s new standards for ethnic and racial data collection.
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Primary Address
 
Mail/Shipping
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Secondary Address
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Additional phone
 
 






Permanent resident number (A#)


calendar [mm/dd/yyyy]

Please select your country of origin. Do NOT select the 'United States' in this case.
Temporary Resident Details



Please select your country of origin. Do NOT select the 'United States' in this case.
I want to apply for the F1/M1 student visa








[m/d/yyyy]
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645 Patriot Ave, Martinsville, VA 24112 l Phone 276.656.0260 l Fax 276.632.1963 l wecd@patrickhenry.edu l www.patrickhenry.edu