REGISTRATION FORM
Questions regarding data collected may be directed to the Registrar. (HB 1922) Registration Form Rev. 09/2019
SOCIAL SECURITY NUMBER GENERAL MANDATORY DISCLOSURE
Disclosure of your Social Security Number (SSN) is required of you in order for The University of Texas at Tyler to complete your request, as mandated by State law (Texas Education Code Ch. 61). Further disclosure of your SSN is governed by the Public Information Act (Chapter 552 of the Texas Government Code) and other applicable laws.
Notice about Information Laws and Practices
With few exceptions, you are entitled on your request to be informed about the information The University of Texas at Tyler collects about you. Under Sections 552.021 and 552.023 of the Texas Government C
ode, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are
entitled to have The University of Texas at Tyler correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that The University of Texas at Tyler collects will be retained and maintained
as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.
Student ID Number: __________________________ Student Name: ____________________________________________________________
Phone Number: _____________________________ Term/Year: Fall Spring Summer 20_____
ADDS ONLY (List Add portion of Swap actions here)
Class
Number
(12345)
Prefix &
Number
Section
Number
(.001)
Course Title
(College Algebra)
Instructor
(Smith)
Permission
Number
(If applicable)
Approval
Code
(See Below)
Written Approvals
(Signature Needed)
DROPS ONLY (List Drop portion of Swap actions here)
Examples:
Course Prefix, Number and Title:
Section Number / 5-Digit Class Number:
WARNING: Dropping classes may affect your financial aid, scholarship(s), degree
plan, or graduation date. Check Cashier’s website for refund information.
part of a
Number
& Number
Number
Course Title
(Grammar & Comp)
Yes □ No
Yes □ No
Office Use Only:
Processed By: _____________ Date Processed: _____________
APPROVAL CODES
Advisors/Instructors/Chairs/Deans/Program Director:
Please assign Approval Code to the column above.
1 Overload (SCHs over maximum allowed; Dean only)
2 Credit/No-credit option (Advisor or higher)
3 Add class late (Instructor, Chair, or Dean)
4 Career Override: 4+1, MAcc , Fast Track, etc.; Chair)
5 Other: _____________________________________
Students requesting any of the above options must receive written
approval on this form from the indicated persons prior to registration.
Submit this form to the One-Stop Service Center (OSC) STE 230,
Longview University Center, Palestine Campus, or Houston
Engineering Center. Students may scan and email the completed
document(s) to Enroll@uttyler.edu from their Patriot email.
