Last First Middle Initial
Social Security#____________________________ Date of Birth________________________ Male Female
Current Mailing Address:
Telephone_____________________________ Email______________________________________________________
Emergency Contact Information
Please indicate information below for an emergency/missing person contact:
Name__________________________________ Relationship Phone______________________
Street_______________________________________________________________ Apartment/Unit#_________________________
City______________________________ State_______ Zip_________________ Country (if other than USA)____________________
Please see the Academic Calendar in regards to the Add/Drop period. The Course Withdrawal/Refund Policy can be found in the Academic
Catalog. This information is also available on
Course Name
Course Number
Registration Status
(Office Use Only)
Statements of Acknowledgment:
I acknowledge course add/drop, withdrawal, and refund policy is detailed in the Academic Catalog and on the Emmanuel
College website. I recognize non-attendance or non-participation does not constitute a drop or withdrawal from a course and
that I must contact the Office of the Registrar directly in writing to change my registration status.
I understand that by registering for the course(s) listed above I will be responsible for the cost of the course(s). Tuition costs
can be viewed via the links below. Questions about tuition and fees should be directed to the Office of Student Financial
Services at (617) 735-9938 or
o Academic Year Tuition:
o Summer Course Tuition:
I agree to pay Emmanuel College all tuition and fees charges incurred by me while attending Emmanuel College. I understand
that I will not have access to an official transcript and that my account may be forwarded to a collection agency if the balance
is not paid in full.
Required Signatures:
Student Signature___________________________________________________ Date_______________________
Please include a handwritten signature or signature using mouse or stylus. Typed signatures will not be accepted
Registrar Use Only: Processed by___________________________________ Date______________________
Non-Matriculating Student
Registration Form