Consortium Application for:
Fisk:
Fisk Dual Degree: Fisk Bridge: Meharry:
Last Name First Name Middle Name
Student’s ID number Date of Birth Place of Birth
Address
Phone
Email
Citizenship
If not a U.S. citizen, list VISA type Sex (M or F)
Check term for which you are applying (Year 20 ):
Fall Spring Maymester
First Summer Second Summer Other
Have you ever applied to Vanderbilt University before? (check one) YES NO If yes, when?
Have you ever attended to Vanderbilt University before? (check one) YES NO If yes, when?
**Have you ever been suspended or expelled from a school? (check one) YES NO
**Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? (check one) YES NO
[Note that you are not required to answer “yes to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed,
annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]
**If you answered “yes” to either or both questions, please attach a separate sheet of paper that gives the approximate date of
each incident, explains the circumstances, and reflects on what you learned from the experience.
Are you Hispanic / Latino?
No
Yes
What is your race?
American Indian / Alaska Native
Asian
Black / African American
Native Hawaiian / Oth Pacific Island
White
Two or more races
I am not a Citizen
Vanderbilt course and
section number requested:
Vanderbilt course title: Home school course number:
I hereby agree to be bound by all policies, procedures, and regulations of Vanderbilt University, both those presently
existing and those subsequently amended or adopted, including the Honor System.
I certify that all information submitted in the admission process is my own work, factually true, and honestly presented. If I
provide false information, I understand that I may be subject to a range of possible disciplinary actions, including admission
revocation, expulsion, or revocation of course credit, grades, and degree.
Signature of Student Date
_________________________________________________________________________ ________________________
Advisor Signature Date
Please return the form to your home school registrar. Obtain the signature of your home school registrar below:
Name and Signature of Home School Registrar Date
Processed by: Date:
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Belmont University
Cross-Registration Form
Revised 11/2017
If you are requesting to take classes at Belmont and would like register for your Spring or Fall
courses, please remember to submit the following:
1. Fisk University Cross Registration Form
2. Fisk University Letter of Good Standing from the Office of the Registrar
3. Your list of desired Belmont courses (class title, CRN, and section #)
4. Belmont University Non-Degree Seeking Application (This step is for student who have skipped at
least one semester or have never attended Belmont University through the Cross-Registration
Program.)
First Name: ______________________ Middle Initial: ___ Last Name: _____________________
Phone Number: _____________________ Fisk E-mail: ____________________________________
Classification (please check one): ____Freshman ___Sophomore ___Junior ___Senior
Major: ________________________________ Semester of Enrollment: _________
Fisk ID: A00000-_____________
Belmont Course
Number & Section
Belmont Course Title
Belmont
Credit Hours
Total Hours: ______
Students Signature: _______________________________________________
Faculty Approval
Advisor Signature: _________________________________________________ Date: ___________
Dept. Chair Signature: ______________________________________________ Date: ___________
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Revised 7/14/2016
CROSS REGISTRATION FORM
Watkins College of Art & Design
NAME: ________________________________ SSN: ___________________________________
PHONE: _______________________________ FISK EMAIL: __________________________________
CLASSIFICATION: ______________________ MAJOR: ________________________________
SEMESTER/YEAR: ______________________ CAMS ID: _______________________________
COURSE TITLE
CREDIT
HOURS
TOTAL HOURS
STUDENT SIGNATURE
DATE
APPROVALS
ADVISOR’S SIGNATURE
DATE
DEPT. CHAIR SIGNATURE
DATE
This form is submitted to Belmont University by the Registrar’s Office.
Fisk University
Office of the Registrar
615.329.8586
registrar@fisk.edu
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