Fillable The University of Texas at Tyler Application for (University of Texas at Tyler)

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The University of Texas at Tyler Application for (University of Texas at Tyler)

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The University of Texas at Tyler
Application for Course Audit
When do you plan to enter UT TYLER? Do you have a bachelor’s degree? □ Yes □ No
Semester: _________________ Year: _______ Social Security Number: _________________________
(Fall, Spring, Long Summer, Summer I, or Summer II)
Last Name: ___________________________________ First Name: _____________________________________
Middle Name: _________________________________ Other Names: ___________________________________
(Include other names that may appear on other documentation.)
Mailing Address: _______________________________________________________________________________
City: _____________________________ State: _______ Zip: _________ Texas County: __________________
Country: __________________ Home Phone: ____________________ Alternate Phone: ___________________
Birth Date: ________________ Place of Birth: ______________________________________________________
City State Country
If you are a US Citizen and were born outside the US, please explain how you became a US Citizen:
_______________________________________________________________________________________
E-mail Address: __________________________________________________________________________
Emergency Contact Name: __________________________ Emergency Contact Phone: ________________
The following information is collected for institutional, state, and federal reports, is optional and will be used in a
non-discriminatory manner, consistent with applicable civil rights laws.
Gender: □ Male □ Female
Ethnicity: □ American Indian or Native American □ Asian or Pacific Islander
□ Black, Non-Hispanic □ Hispanic □ White, Non-Hispanic
Special Audit Information:
1. A student may not audit a course offered on an individual instruction basis, a course requiring the
use of laboratories, computer or studios, receive credit for the course, nor be eligible for advanced
standing examination.
2. Participation in class activities is at the discretion of the instructor.
3. A student who audits a class is not eligible to use the library, fitness center, or computer labs.
4. A student who audits a class must have a valid UT Tyler parking permit. The parking permit is in
addition to the audit fee.
5. A student who audits will not be issued a UT Tyler student ID card.
6. A student who audits a course must meet the bacterial meningitis vaccination requirements.
I have read and understand the Special Audit Information listed above. _________________________
Initial Date
I certify that the information on this application is complete and correct to the best of my knowledge. If my
application is accepted, I agree to abide by the policies, rules and regulations at The University of Texas at Tyler. I
authorize the university to verify the information I have provided. I further understand that this information will be
relied upon by the officials of the university in determining my admission and that the submission of false
information is grounds for rejection of my application, withdrawal of an offer of acceptance, cancellation of
enrollment, and/or disciplinary action.
Signature: _____________________________________ Date: ___________________________
General Information
1. Complete the Course Audit Request form available in the Enrollment Services Center (ESC).
2. A student may not audit a course offered on an individual instruction basis, a course requiring the use of
laboratories, computer or studios, receive credit for the course, nor be eligible for advanced standing
examination. Participation in class activities is at the discretion of the instructor.
3. Social Security Number: Disclosure of your Social Security Number (“SSN”) is requested for the student
records system of The University of Texas at Tyler (the “University”) and for compliance with Federal and
State reporting requirements. Federal law requires that you provide your SSN if you are applying for
financial aid. Although an SSN is not required for admission to the University, failure to provide your SSN
may result in delays in processing your application or in the University’s inability to match your application
with transcripts, test scores, and other materials. Student SSNs are maintained and used by the University for
financial aid, internal verification, and administrative purposes, and for reports to Federal and State agencies
as required by law. The privacy and confidentiality of student records is protected by law and the University
will not disclose your SSN without your consent for any other purposes except as allowed by law.
4. 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 Code, you are entitled to received 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. (Sections 441.180 et seq. of the Texas Government Code) and rules. Different types of information are
kept for different periods of time.
5. Special Accommodations: If you have a disability for which you need accommodation, please contact the
Office of Counseling and Testing in University Center 282 or at 903-566-7079 (TDD 565-5579). In order to
receive accommodation the first week of class, an application for accommodation and verification
information from a qualified professional must be on file 30 days before classes begin each semester.
6. Questions regarding data collected may be directed to the Registrar at 903-566-7469.
Mail or fax completed application to:
The University of Texas at Tyler
Enrollment Services Center
3900 University Blvd
Tyler, TX 75799
Fax: 903-566-7183
Phone: 1-800-UT TYLER
enroll@uttyler.edu
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Completed 30 August 2020

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