Please print or type. A completed Registration Approval form for each class must be attached and full payment included. Mail, deliver or fax to
UW Non-Degree Registration Services, P.O. Box 45010, Seattle, WA 98145-0010 or call 206-543-2310, (FAX) 206-685-9359.
For additional forms, fees and information please visit our website at:
www.nondegree.uw.edu
To request disability accommodations, contact UW Disability Services Office at 206-543-6450 (Voice), 206-543-6452 (TDD), OR 206-685-3885 (FAX).
(First)
(Last)
(City)
(Street)
(Middle)
(Apt.)
(ZIP)
(State)
Home Telephone
Social Security Number (Indicate if none exists)*
Date of Birth (Mo., Day, Yr.)*
Gender:
Former Name (If applicable)
Work Telephone
Address
Name
* Social Security Number and Birthdate: For purposes of the new Hope and Lifetime Learning tax credits, federal law (section 6109 of the Internal Revenue
Code) requires the University to obtain your Social Security number.
NONMATRICULATED (NM)
GRADUATE NONMATRICULATED (GNM)
STUDENT REGISTRATION
Female
Male
Email Address
– –
– –
Are you currently on drop
status for low scholarship ?
NoYes
Are you a currently enrolled
high school student ?
UW Student # (Please leave blank if you don't have a UW # or if you don't know it.)
If yes, you must submit high school transcripts and attach a letter from your high school
guidance counselor or principal. Students must have completed ninth grade.
NM
Total Fees
Reg Number
Dept.
Abbreviation
(Office Use)
Course
Number
Course
Section
of
Number
Credits
FeesCourse Name
SLN
COURSES REQUESTED
Late Fee
Registration Fee
TECHNOLOGY FEE
METHOD OF PAYMENT
Third-party payer – Separate document (purchase order or
letter of authorization to bill) must accompany registration
form each term.
Check made payable to the University of Washington
(Returned checks are subject to $25 service charge.)
Credit Card (Provide card type, number, expiration at right)
Please check the box that indicates your payment method.
VISA MasterCard American Express
Credit Card No.
Credit Card billing address for Third-party payer
PRINT name as it appears on card
Expiration Date
OFFICE USE ONLY
Entered By
Payment No.ID Number
DateF/C/Mail
Signature
GRADING OPTION
NoYes
Signature X
Date
Satisfactory/Not Satisfactory Audit Standard Grading (A–F)
Quarter
Year 20
UoW 1512 (Rev. 8/19)
GNM
This form is dynamic. Simply type in your information, and your fees will be
automatically calculated. Then just print out the completed form. If you prefer to fill out
the form by hand, you may print it out now without entering any data.
On your computer please fill in the course description including the course fees (the Fees field is immediately below, far right).
The form will automatically calculate your total.
