Undergraduate
Non-degree Enrollment Request
Full Name______________________________________________________SS# or LU id# _______________________
Last First Middle
Home Address______________________________________________________________________________________
Street / City / State / Zip
County______________________________Telephone________________________Cell__________________________
Work Address______________________________________________________________________________________
Name / Street / City / State / Zip
Email____________________________________@__________________Telephone (w)_________________________
Are you US citizen? Y N If No, Country?________________________________________VISA Type__________
DOB_____________________________Marital Status_________________Ethnic Heritage________________________
Do you have a high school diploma/GED ? Y N- School Name_________________________________________
Education
What is your highest college degree earned ? ________________________School Name__________________________
Have you applied for admission to Longwood? Y N- When?__________________Outcome__________________
Previous Longwood Enrollment? Y N- Last term enrolled______________________________________________
Have you ever been convicted or pending final action, of a criminal offense other than a minor traffic offense? Y N
Have you ever been subject to disciplinary action from a school resulting in probation, suspension or dismissal? Y N
Non-degree seeking students may be permitted to take courses for which they are qualified and must meet any prerequisites and admission
standards. Students who have been denied regular admission to an undergraduate program at Longwood may not register as non-degree
students without permission from the Dean of Admissions and the Dean of the College of the student’s intended major. Non-degree
students must maintain at least a “C” average in order to continue enrollment. Non-degree students who wish to carry a full-time load (12
credits or more) must have permission from the Dean of the College. Credits earned as a non-degree student are not necessarily applicable
toward a Longwood degree program. If a student
audits a course
, he or she does not receive academic credit and is charged the regular
rate of tuition and fees. Complete academic regulations and policy is available online at ww.longwood.edu/registrar.
Enrollment Request
Please review the course description for prerequisites and restrictions at www/longwood.edu/registrar and open the
Course
Schedules
link. Non-degree students must meet all requirements.
Audit
Y/N
CRN
Course
ID/Section
Course Title
Credit
hours
Meeting
days
Meeting
hrs
Location
Office use
N
01234
Eng 150-1
Writing and Research
3
MWF
8-8:50
GRN101
IN COMPLIANCE WITH STATE LAW, INFORMATION PROVIDED ON THIS REGISTRATION FORM WILL BE SENT TO THE VIRGINIA STATE
POLICE AND OTHER STATE OR FEDERAL AGENCIES.
The public is hereby placed upon notice that failure to pay account in full at the time services are rendered will result in the imposition of a 10% Late Payment Fee on the unpaid balance. Refer to the University Catalog for
estimated E-bill notification and semester payment due dates. Any charges assessed after the original semester payment due date are due and payable at the time incurred. For course registrations requested after the semester
payment due date, tuition-fee payments are due at the time of registration. Returned items will incur a handling fee of $50.00. If the matter is referred for collection to an attorney or to a collection agency, then the debtor will
be liable for attorney’s fees or additional collection fees of up to 30% of the then unpaid balance. Requesting or accepting services will be deemed as acceptance of these terms.
During each summer session, Intersession, or regular (fall-spring) semester, students wishing to drop without financial penalty must do so through myLongwood (if accessible) or must submit a completed, signed Schedule
Change Form to the Registrar’s Office prior to the drop deadline for each course. After course drop deadline, students wishing to withdraw (without academic penalty) must submit a completed, signed Course Withdrawal
Form to the Registrar’s Office before deadline to withdraw with “W” grading. (Please refer to the following web-site for official academic policies and forms: www.longwood.edu/registrar.) Students withdrawing without
academic penalty will be assessed full tuition and fee charges for course(s) graded “W”. Students registered for contractual (off-campus or online) classes follow the policies as outlined in the contract with the
applicable agency.
I understand that I will be responsible for all charges assessed regardless of any arrangements or agreements made with other parties.
By my signature I agree to the provisions of the LONGWOOD UNIVERSITY HONOR CODE, as found in the Student Handbook, the tuition and fees policy
above, and to the Virginia State Police compliance statement above.
Please submit form to the Registrar’s Office; Fax 434-395-2252, or Longwood University, Registrar’s Office, Barlow Hall, 201 High St, Farmville VA 23909
Student Signature: ________________________________________________________ Date: ________________________________________________________
Fall____Spring_____Summer____
Year________________________
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