Fillable C ROSS REGISTRATION FORM (Union College)

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C ROSS REGISTRATION FORM (Union College)

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The C ROSS REGISTRATION FORM (Union College) form is 2 pages long and contains:

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  • 8 check-boxes
  • 33 other fields

Country of origin: US
File type: PDF

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C
ROSS REGISTRATION FORM
A. Please supply all information requested. If you have any questions, see the Union Registrar’s Office.
B. Obtain any approval or signature(s) required by Union College BEFORE you go to the host school.
C. Return original copy to the Union Registrar’s Office.
1. Name: Mr./Ms.
(Last) (First) (Middle Initial)
2. D.O.B. Student ID #
3. Permanent Address:
(# and Street)
(County) (City) (State) (Zip)
4. Email Address:
5. Cell Phone # Home Phone #
6. Local Address:
(If different from Permanent)
7. Class Year (during term of study for which you are applying) Major:
8. Host Institution: Sem/Qtr Year
Have you cross-registered at this school in the past?
Course for which you are applying:
Dept / Number Section Title: Credits
Dept / Number Section Title: Credits
9. Student’s Signature: Date:
TO BE SIGNED BY FACULTY ADVISOR & APPROPRIATE OFFICIAL(S)
The above-named student is in good academic standing and is expected to be a full-time student for the term in question. I
recommend approval of the request.
Faculty Advisor’s Signature Date:
Union Registrar Signature Date:
Host Institution Registrar Signature Date:
Registrar’s Office
Silliman Hall
Schenectady, NY 12308
Phone 518-388-6109
Fax 518-388-6173
registrar@union.edu
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THIS IS A TWO PART QUESTION; PLEASE ANSWER QUESTIONS IN BOTH SECTIONS, A. and B.
A. Ethnicity: Are you Hispanic/Latino? Please circle one: Yes No
Hispanic: A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin; regardless of race.
B. Race: Please select one or more of the following racial categories to describe yourself:
[ ] WHITE: A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
[ ] AMERICAN INDIAN OR ALASKAN NATIVE: A person having origins in any of the original peoples of North and South America (including
Central America) who maintains cultural identification through tribal affiliation or community attachment.
[ ] BLACK or AFRICAN AMERICAN: A person having origins in any of the black racial groups of Africa.
[ ] ASIAN: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for
example: Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
[ ] NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands.
[ ] NON RESIDENT ALIEN: A person who is not a citizen or national of the United States and who is in this country on a visa or temporary basis.
Please Note: This information is requested so that Union College can complete a required Federal “compliance
report” under Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972.
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C ROSS REGISTRATION FORM (Union College)

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Completed 28 August 2020

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