Part Time Student Registration Form
Application must be on file before submitting this form
Part I: To be Completed by Student (please print): Term/Year______________
Union College I.D. No.:_____________________
(If unknown, or first time student, leave blank)
Name: ________________________________________________________
Last Name First Name
Local Address: _________________________________________________
Phone: (H) ___________________________ (W):___________________
Email Addr: ___________________________________________________
Part II: Course Selection:
Course name (ie: HST) Course Number (ie: 240) Section (ie: 01) Please Check One
__________________ ___________________ _____________ For Credit _______
Title:________________________________________________________ For Audit _______
Course name (ie: HST) Course Number (ie: 240) Section (ie: 01)
__________________ ___________________ _____________ For Credit ______
Title:_________________________________________________________ For Audit ______
Student Category (Please check all applicable)
1. _____Non-degree
2. _____Degree-seeking :
Major? ______________________
3. _____Employee/Spouse/Dependent
4. _____High School
5. _____UCALL
6. _____Senior Citizen
Failure to notify the Registrar’s
office, in writing, of withdrawal
will result in an automatic “F” on
your transcript.
For Office Use Only
Processed by: ______________________
Date: ______________________________
I, the undersigned agree to be responsible for and to pay Union College for the balance of my account, including collection or attorney fees incurred should I fail to
meet my obligations:
Student’s signature (REQUIRED) __________________________________________________________________________
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