_________________________________________________________________________
_____________________________________________ _______________________________
St. Lawrence University Canton, NY 13617
SPECIAL STUDENT ENROLLMENT FORM
□ High School Student □ Employee □ Employee Child □ Employee Spouse □ Other
Instructions: 1) Submit this completed form to the St. Lawrence University Registrar’s Office.
2) Obtain Add/Drop or Summer Registration form at Registrar’s Office.
3) Obtain instructor’s signature on Add/Drop form.
4) Those using employee benefit complete form in Human Resources Office.
5) Take Add/Drop or Summer Registration form to Student Financial Services.
6) Present Add/Drop or Summer Registration form, complete with Financial Clearance stamp, at Registrar’s
Office.
PERSONAL DATA:
Mr./Mrs./Miss___________________________________________________________________________________
. (last name) (first) (middle)
Mailing Address: _________________________________________________________________________
(city) (state) (zip code)
Home Phone #:
_________________ Cell Phone #:_________________ Email: _____________________________
Date of Birth: _____________ Soc. Sec. #: ___________________ Parents Name(s): _____________________________
SLU employee:
□ yes, □ no
Ethnicity:
□ Non-Hispanic/Latino , □ Hispanic/Latino Race: □ White, □ Black or African American, □ Asian,
□ American Indian or Alaska Native,
□ Native Hawaiian or Other Pacific Islander
Email:____________________________________________________
Emergency Contact ____________________________________ Phone:____________________________
EDUCATIONAL DATA:
Secondary School: _____________________________________________________________________________
Previous College/University: _____________________________________________________________________
This enrollment will be during the (Fall) / (Spring) / (Summer) of 20___ only.
Signing below acknowledges that the applicant has read and signed the St. Lawrence University academic honor code.
Applicant’s Signature ___________________________________________ Date __________________________
FINANCIAL GUARANTEE
In consideration of the acceptance of the above student as a Special Student at St. Lawrence University, the undersigned, as
parents or guardians, hereby guarantees payment of all fees for tuition, housing, and all other financial obligations incurred or
hereafter incurred by the said student while in attendance at St. Lawrence University.
Parent signature(s) (for dependent students): ___________________________________Date:__________
Student signature (if independent): ___________________________________________Date:__________
Parent’s mailing address (if different than student’s): _____________________________________________
(Street)
_____________________________________________
(City) (State) (Zip)
OFFICE USE ONLY:
The student has been approved for enrollment as a Special Student when the Registrar signs this form.
(Registrar) (Date)
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