AUDIT FORM
Please see reverse side prior to completing this form. Deadlines apply.
Return this form to the Registrar’s Office: AS-Registrar@Asnuntuck.edu
Student ID#: _________________________
Last Name: __________________________ First Name: ____________________ Middle/Maiden: _____________
Term:
□ Spring □ Summer □ Fall □ Winter Year __________
I am a Financial Aid recipient: ____ Yes ____ No
I am a Veterans Educational Benefits recipient: ____Yes ____ No
If yes, Veteran Approval: ____________________________
I would like to audit the following course:
___________ _____________ __________ ____________________________________
(CRN) (Subject)
(Course #)
(Course Title)
_____________________________________________________________________________________________
I certify by my signature that I have read the Audit Policy on the reverse, and I am aware of the effect on my
student status this request will cause.
Student’s Signature: _______________________________ Date: ________________________
Instructor’s Signature: ______________________________ Date: ________________________
Registrar’s Office Use Only
Banner Updated: __________________________________
Notice of Non-discrimination: Asnuntuck Community College does not discriminate on the basis of race, color, religious creed, age, sex, national origin,
marital status, ancestry, present or past history of mental disorder, learning disability or physical disability, sexual orientation, gender identity and
expression or genetic information in its programs and activities. In addition, the College does not discriminate in employment on the basis of veteran status
or criminal record. The following individuals have been designated to handle inquiries regarding the non-discrimination policies: Yhara Zelinka, Title IX
Coordinator, yzelinka@asnuntuck.edu (860) 253-3092 and Deborah Kosior, 504/ADA Coordinator, AS-DisabilityServices@asnuntuck.edu (860) 253-3005,
Asnuntuck Community College, 170 Elm Street, Enfield, CT 06082.
Políticas Antidiscriminatorias: Asnuntuck Community College no discrimina por razones de raza, color, creencias religiosas, edad, género, nacionalidad,
estado civil, ascendencia, historia presente o pasada de discapacidad mental o física, problemas de aprendizaje, orientación sexual, Identidad y expresión de
género, o información genética, en sus programas o actividades. Adicionalmente Asnuntuck no discrimina individuos por razones pertinentes a la categoría
de veteranos o historia criminal. Las siguientes personas han sido designadas para resolver cualquier inquietud pertinente a las políticas antidiscriminatorias:
Yhara Zelinka, Title IX Coordinator, yzelinka@asnuntuck.edu (860) 253-3092 and Deborah Kosior, 504/ADA Coordinator, AS-
DisabilityServices@asnuntuck.edu (860) 253-3005, Asnuntuck Community College, 170 Elm Street, Enfield, CT 06082.
Updated April 2020
REQUIRED
