November 24, 2014, Graduate_Enrollment.doc
GRADUATE ENROLLMENT FORM
If at all possible, please enroll on line. Instructions can be found at:
http://www.stevens.edu/sit/registrar/policies-procedures/
PLEASE PRINT CLEARLY OR TYPE ALL INFORMATION
CHECK HERE IF YOUR ADDRESS HAS CHANGED
STUDENT IDENTIFICATION NUMBER
LAST NAME FIRST MIDDLE DATE OF BIRTH (MM/DD/YYYY) MALE
FEMALE
HOME ADDRESS STREET APT.
EMAIL ADDRESS
CITY STATE ZIP CODE PHONE HOME
MOBILE
SEMESTER: FALL WINTER SPRING SUMMER I SUMMER II YEAR TERM 20 ____
SPECIAL NOTES ABOUT ENROLLMENT
It is the student’s responsibility to drop/withdraw from an enrolled course. Non-attendance, for example, will not drop you from a course and you will still
be financially responsible for the course.
If tuition is being paid by a third party (sponsor, employer, etc.), and they do not pay, responsibility to pay falls to the student.
Enrollment into more than 12 credits requires the approval of the advisor and the Dean of Graduate Academics.
Initial Study Plans are due by the mid-point of the term. Failure to submit a Study Plan will result in not being allowed to enroll in subsequent terms.
The Application for Candidacy (A/C) is an absolute requirement for graduation.
If you are completing in the fall, your A/C must be submitted by October 1 in the term you that are completing the degree.
If you are completing in the spring, your A/C must be submitted by February 15 in the term you that are completing the degree.
COURSE NUMBER
EX: MGT 609
SECTION
EX: A
COURSE SECTION TITLE
EX: Project Management Fundamentals
INSTRUCTOR SIGNATURE
(IF NEEDED)
REASON FOR APPROVAL
(E.G., WAIVE PREREQ AND/OR CAP)
(INSTRUCTOR USE ONLY)
CREDITS
EX: 3
TOTAL
ONLY COMPLETE THIS SECTION IF YOU HAVE NOT PROVIDED THIS INFORMATION BEFORE.
If you have not provided your Social Security Number to Stevens before, it is not required, but strongly recommended that you do so. Please enter it in the Student Identification
umber box at the top of the form.
In conjunction with the Civil Rights Act of 1964 of the United States Department of Health, Education and Welfare, we are required to collect basic racial-ethnic information of
the student body at Stevens. This information is needed for many state and federal reports and it is held as confidential material and will not be released without your consent.
Only statistical data is released to government or any agencies. It is not mandatory for you to complete this section; however, we would appreciate your cooperation in
assembling this necessary data. Some Government funding, which Stevens receives, is based upon this data.
ETHNICITY: RACE (CHOOSE ONE OR MORE):
HISPANIC OR LATINO AMERICAN INDIAN OR ALASKA NATIVE
NOT HISPANIC OR LATINO ASIAN
BLACK OR AFRICAN-AMERICAN
HAWAIIAN OR OTHER PACIFIC ISLANDER
WHITE
STUDENT SIGNATURE (REQUIRED) DATE
ADVISOR APPROVAL (IF REQUIRED) DATE
OFFICE OF GRADUATE ACADEMICS APPROVAL (IF REQUIRED) DATE
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