CROSS REGISTRATION FORM FOR UNION & SIENA COLLEGE
CLARKSON UNIVERSITY - CAPITAL REGION CAMPUS (CRC)
80 NOTT TERRACE, SCHENECTADY, NY 12308
518-631-9832 | FAX 315-268-2321
*LIM Students must obtain the signature of their Clarkson University Advisor, and Union College Registrar’s office. An advisor from Union College does not need to
sign this form.
Rev 11/2018
In general, the institutions in the consortium schedule different start and end dates, and vacations. The student is responsible for arranging to keep up with coursework
despite calendar disjunctions and, in some cases, must arrange for food and lodging when residence halls at their Home Institution are closed. Students will be enrolled
as part-time, non-matriculated students at CRC until such time a bachelor’s degree has been awarded. Students must abide by CRC’s attendance regulations, honor
systems, parking regulations, etc. Students must also adhere to CRC’s policies and procedures for incompletes, withdrawals, pass/fail, fees, or adding/dropping.
Last Name:
First Name:
Middle Initial:
DOB:
Gender:
Non-Clarkson Email address:
Home Institution:
Union College Siena College
Home Inst. ID:
Have you ever taken a course at Clarkson before? Yes* No
*If yes, Clarkson ID:
Permanent Address:
Local Address:
(where you live while in school)
Country:
Phone:
Home Mobile
Required: Are you a US Citizen? Yes No (if no, complete the following):
Country of Citizenship:
Current Immigration Status:
When do you anticipate receiving your bachelor’s degree:
Please indicate which Cross-Registration program you qualify for:
Early Admission - Siena
Early Admission - LIM
Early Admission - Union
Union Student
Union Employee
Union Employee Dependent
See page 2 of this document for more information on cross-registration programs available.
Course Information (to facilitate course enrollment, please list all information requested below)
*Distance courses are denoted by a section number which begins with a “6” and may not be accepted for credit at your Home Institution. Contact your
Registrar’s office for verification.
Class #
Subj & Cat #
Section
Credits
Home Equivalent Crs
Term/Year
Fall Winter Spring 20_____
You must fill out a new form each term you wish to enroll
The Family Educational Rights & Privacy Act of 1974, Public Law 93-380, Section 483 requires the written consent of the student before any information, other than
directory, can be released. By your signature on this form, you are allowing Clarkson University to furnish a copy of this form, a class schedule, and an official academic
transcript to your Home Institution.
Student Signature
Date
Home Institution Advisor*
Signature
Date
Clarkson University Advisor
or Program Director
Signature
Date
Home Institution Registrar or HR Office
1
Date
Clarkson University Registrar’s Office
1
Certifies the student/employee is eligible for cross-registration
Enrolled:
Y N
Date:
email:
If no, reason:
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
CROSS REGISTRATION FORM FOR UNION & SIENA COLLEGE
CLARKSON UNIVERSITY - CAPITAL REGION CAMPUS (CRC)
Rev 11/2018
Union College, Siena College, and Clarkson University Capital Region Campus (CRC) are separate institutions. All Union or
Siena College undergraduate students, and Union College employees/dependents wishing to take graduate courses offered
by CRC must complete this Cross Registration form. Cross Registration is offered on a space-available basis only, and
enrollment in selected courses is not guaranteed. Students will pay tuition to their Home Institution, but will be responsible
for any special fees, such as (but not limited to) lab fees, late fees, or any tuition charges associated with additional credits
taken in excess of what is covered by the cross-registration agreement.
Information and instructions for Siena and Union students in early admission (accelerated) programs:
Students in early admission programs have been formally accepted into a Clarkson University graduate program, and should
follow the instructions, below:
1. Obtain the list of available courses from Clarkson University’s Courses and Schedules website (link).
2. Select a course (or courses) in consultation with your Home Institution academic advisor and obtain
their signature on this form.
3. Take the signed form to your Home Institution’s Registrar’s office for certification that you meet the
eligibility criteria to cross-register.
4. Return (or have your Registrars office email) the signed form to the appropriate Clarkson University
academic advisor for verification that you meet the requirements to enroll in the selected course(s)
see list of advisors below.
5. The Clarkson University Registrars office will receive the fully signed form from the Clarkson University
advisor. You will receive email confirmation from the Clarkson University Registrars office once your
enrollment has been processed.
Limitations: With the exception of LIM students, any student accepted into an early admission program is
limited to three (3) cross-registered courses at CRC. Any courses taken in addition to the three covered
courses will be billed at the standard tuition rate in effect at the time of registration.
Additional Information for LIM Students:
No payment or deposit is required at the time you submit your cross-registration form, but LIM-MBA seniors
will be billed during their final term of the program.
*LIM Students must obtain the signature of their LIMy Advisor and Union College Registrar’s office. An
additional advisor signature is not required for this program.
Information and instructions for all other Union College constituents:
1. Obtain approval to take a graduate course from your Home Institution academic advisor, and your
Home Institution’s Registrar’s office (students) or HR office (employees/dependents).
2. Schedule an appointment with the appropriate Graduate office to secure their approval to enroll (see
contact information, below).
3. Take the signed form to CRC’s Student Administrative Services office, located on the 1
st
floor of 80 Nott
Terrace. Office hours may vary, but are typically Monday through Friday, 8:00am-4:30pm. You may also
scan and email the form to CRCRegistrar@clarkson.edu.
Limitations: Union College students are limited to two (2) cross-registered courses at CRC. Union College
employees should refer to their HR office for details regarding number of courses approved under the cross-
registration benefit.
Clarkson University Contact Information
Institute for STEM Education
Catherine Snyder, Chair
518-631-9870, csnyder@clarkson.edu
School of Engineering
Hugo Irizarry-Quinones, Associate Dean
518-631-9881, hirizarr@clarkson.edu
School of Business
Chris Wszalek, Director of Grad Bus Programs
315-268-7799, cwszalek@clarkson.edu
Student Administrative Services
Student Records Specialist 315-268-6451, registrar@clarkson.edu
By signing this form, you authorize Clarkson University to provide an official transcript to your Home Institution as
evidence of course completion.