GOUCHER INTERNAL COHORT REGISTRATION FORM
Semester of Application: Year ____ Summer Fall Spring
Degree of Interest: M.ED Degree Professional Development Cert. (post master’s)
Individual Coursework Only
Cohort of Interest: Early Childhood Special Ed for Certified Teachers Reading
Instruction School Improvement Leadership Special Education for Conditional
Teachers Secondary Education for Conditional Teachers
1021 Dulaney Valley Road, Baltimore, MD 21204
PH 410.337.6200 FAX 410.337.6085
Are you a citizen of the United States?
If no, what is your country of citizenship?
*Please indicate any former names that are present in our system or on your records. Please check if your address or email have changed
REGISTRATION FOR Year ____ Summer Fall Spring
Tuition: $300 X ___ Credits=
Registration Fee: $60 X ___ Credits
Students must select one of the following payment methods:
Full payment enclosed (check or money order only-
no cash
)
Credit card payment will be made through secure online processing at www.goucher.edu/webpay once a statement of account is sent by the
college. Billing statements are sent to your Goucher email address.
I understand that the $60 per credit registration fee is required and Non-Refundable. Further,
I acknowledge that I am responsible for payment of all tuition and registration fees and
charges to personal accounts. These may include expenses incurred at the bookstore, the
library, and all other facilities that extend credit or charge student accounts. I also
understand that if I do not complete the course I will be responsible for paying the tuition
directly to Goucher College. I agree to reimburse the College for collection agency fees,
attorney’s fees, and all other costs and expenses incurred in collection efforts which may be
based on a percentage of the debt, should charges not be paid when due. I understand that I
am responsible for signing and abiding by the FERPA release.
SIGNATURE-REGISTRATION IS NOT VALID WITHOUT SIGNATURE AND DATE
All Goucher internal cohort participants will be provisionally accepted; you will then submit remaining
documents in order to be fully matriculated as a degree seeking student.
If your name legally changes during the time that you are a student at Goucher College, you are responsible for notifying
the college and providing legal documentation (ex. Driver’s license, divorce decree, or S.S. card) as well as a written
request to change your name and a new FERPA Release Form for billing.
Goucher College is an equal opportunity institution that does not discriminate on the basis of orientation, color, age,
religion, national or ethnic origin, disability, or handicap in its personnel, admissions, educational policies, scholarship and
loan programs or other programs.
