Adult Continuing Education (ACE) Non-Credit Registration Form
STUDENT INFORMATION (PLEASE COMPLETE ALL FIELDS AND PRINT CLEARLY)
Address
Apartment
City
STUDENT GENDER:
Date of Birth (MM/DD/YYYY)
State
Primary Phone: Secondary Phone:
Year: 20
Zip Code
Primary Email Address (confirmation will be sent here)
Last Name First Name Preferred Name MI ID # (if returning)
FemaleMale
Fall Winter Spring Summer
Signature required of student or parent/legal guardian if student is under 18 years of age.
Date
X
COURSE SELECTIONS
Class number Class dates Day(s) Meeting timesTitle
Class number
Class number
Class dates
Class dates
Day(s)
Day(s)
Meeting times
Meeting times
Title
Title
OPTIONAL
Yes NoDo you consider yourself to be Latino/Hispanic?
In addition, select one or more of the following racial categories to describe yourself:
How did you hear about us?
Native American Asian WhiteBlack or African American
A New SAIC studentI am : A Returning SAIC student A Certificate Program student
Native Hawaiian
Brochure Email Friend I am a returning student SAIC Website Teacher
Other
The Art Institute of Chicago
EMERGENCY CONTACT INFORMATION
Email address
Relationship to student
Last Name First Name
Phone: Mobile Home Work
Mobile Home Work Mobile Home Work
CONTINUING STUDIES ACKNOWLEDGMENT + AGREEMENT
I
understand that I am financially responsible for the course(s) for which I am registering.
A 100 percent tuition refund will be issued one week prior to the session start date. All requests to drop a course must be submitted in writing
to cs@saic.edu and include the student’s name, ID number, and course information.
I give SAIC permission to obtain emergency medical care, hospital, or clinic treatment for me.
I hereby waive liability against SAIC for such care and for transportation provided to such locations as deemed necessary by SAIC.
I have read and agree to abide by the Rights and Responsibilities for ACE Students, available online at saic.edu/ace > Forms and Downloads
I have read and agree to the terms outlined on the ACE Media Consent Form, available online at saic.edu/ace > Forms and Downloads
I agree with the foregoing on behalf of myself/my child or ward.
All students will receive an ARTICard, SAIC’s mandatory identification card. Please visit saic.edu/articard for more information.
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ARTICARD (Student ID)
click to sign
signature
click to edit
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