Fillable Graduate NON-DEGREE Application Term of Enrollment Personal Information (University of Alabama at Huntsville)

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Graduate NON-DEGREE Application Term of Enrollment Personal Information (University of Alabama at Huntsville)

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The Graduate NON-DEGREE Application Term of Enrollment Personal Information (University of Alabama at Huntsville) form is 2 pages long and contains:

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Preferred Name
Email Address
Mailing Address:
Street
City
State Postal/Zip County
Daytime Telephone
Gender:
o
Male
o
Female
Emergency Contact
Daytime Telephone
Residency
Is Alabama your permanent, legal state of residence?
o
Yes
o
No
(Not for F -1 or J-1 Visa holders)
If yes, when did your residency in Alabama begin? Month Year
If not a US Citizen, Country of Citizenship
Visa Type
You must submit immigration paperwork and/or a copy of your passport in which
your visa is stamped.
o
Permanent Resident
o
Permanent Alien Registration Number (if assigned):
(A copy of your Green Card is required if you are a permanent resident.)
Have you ever been convicted of a criminal offense?
o
Yes
o
No
If yes, please explain:
Ethnic Background
The University of Alabama in Huntsville (UAH) recruits and admits students without
regard to race, color, age, sex, creed, national origin or handicapped status.
However, in order to comply with federal reporting regulations we request that you
supply the following information regarding your ethnic background.
1. Are you Hispanic or Latino?
o
Yes
o
No
2. Please select one or more of the following racial categories:
o
Black or African American
o
American Indian or Alaska Native
o
Asian
o
Native Hawaiian or Pacic Islander
o
White
Native Language
If your native language is not English and you later wish to pursue a graduate degree,
you must take the English Language Placement Test (ELPT) prior to registering for
further classes.
Date of Birth Place of Birth
MM/DD/YYYY
Education
Where did you receive your bachelor’s degree?
NAME OF DEGREE GRANTING INSTITUTION
Degree receive: Year:
Have you ever been dismissed, suspended, or expelled from a college or university?
o
Yes
o
No If yes, please explain:
Ofce use only: Paid
Personal Information
PLEASE PRINT CLEARLY OR TYPE YOUR FULL LEGAL NAME
Last Name First Name Middle Name
o Spring o Summer o Fall _________ Year
Term of Enrollment
Graduate NON-DEGREE Application
A NON-REFUNDABLE APPLICATION FEE OF $60
must accompany your application. Fee is subject to change. Visa, MasterCard, Discover and
American Express are accepted. If paid by check, check must be encoded with the bank number and must be denominated in U.S. dollars.
NOTE:
Students who enroll as a graduate non-degree student are NOT eligible for Federal Financial Aid.
o
I understand I will not be eligible for Federal Financial Aid.
First Semester Courses
Please list ALL courses for which you plan to register in your rst semester as a Graduate Non-Degree Student:
COURSE NUMBER DEPARTMENT DEPARTMENT CHAIR or PROGRAM CHAIR NAME AND SIGNATURE
EX: ACC 600 | BUSINESS | Jennifer Pettitt X Jennifer Pettitt
1. | | X
2. | | X
3. | | X
4. | | X
Do you plan to purse an advanced degree at UAH?
o
Yes
o
No
If yes, please be aware that non-degree seeking students may transfer a maximum of 12 credit hours earned while enrolled as non-degree to an advanced degree at UAH.
o
Yes, I understand the above statement.
CHECKLIST MUST BE COMPLETED
o APPLICATION
I have completed the application entirely and there are no unanswered questions (if incomplete, your form will be returned to you for
completion and may delay the application process and/or registration).
o BACHELOR’S DEGREE
I have included a copy of my bachelor’s degree (an unofcial transcript is also acceptable).
o DEPARTMENT CHAIR’S APPROVAL
I have obtained signatures from the department/program chair for the courses in which I would like to register.
o APPLICATION FEE
I have included a check for the $60.00 application fee (credit card is also acceptable).
CERTIFICATION
I certify that I comply with the provisions of the United States Military Selection Service Ac (50 U.S.C. Appendix 453) by having
registered with the Selective Service Board, or that I am not 18 years of age and I will register when required, or that I am not required by law to register.
Date_______________________________ Signature_________________________________________________________________
VALIDATION
I certify that the information given in this application is true and complete and that I have not misrepresented by assertion or omission
any fact which I have been asked to supply. I understand and agree that UAH may investigate these facts and information to verify their accuracy. I
acknowledge a continuing duty to inform Graduate Admissions of any material changes in the facts and information provided herein. By submitting this
application, I agree to comply with all University policies, rules, and regulations, including the Code of Student Conduct, which relate to my conduct in
the application process and subsequently, to my conduct while I am a UAH student. In doing so, I promise or afrm that I will not at any time be involved
in cheating, plagiarism, fabrication, misrepresentation, or any other form of academic misconduct while I am enrolled as a student at UAH. I understand
that violating this promise can result in penalties as severe as indenite suspension from the University.
Date_______________________________ Signature_________________________________________________________________
If you prefer not to be listed in the Student Directory or not to have directory information released, please check here.
o
Rev. 3/14
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Graduate NON-DEGREE Application Term of Enrollment Personal Information (University of Alabama at Huntsville)

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Completed 28 August 2020

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