Office of the Registrar 10/20
University of Detroit Mercy
Advising and Registration/Change in Registration Form
PLEASE PRINT CLEARLY TO ENSURE ACCURATE PROCESSING
Student ID Number: T0_________________________ □ Fall (10) □ Winter (20) □ Summer (30) 20_____
Name: ________________________________________________________________________________________
Last First Middle
Address: ______________________________________________________________________________________
Street City State Zip
Telephone: ( ) ________________________ Work: ( ) ____________________________
Email Address: _______________________________________________ Birthdate: _______/_______/________
College/School: Undergraduate Graduate:
Student Status: Student Status:
____Architecture ____Engineering & Science ____New Freshman ____New Graduate Student
____Business Administration ____Health Professions/Nursing ____New Transfer/Post Deg ____Continuing Student
____Dental Hygiene ____Liberal Arts & Education ____Continuing Student ____Unclassified/Other
____University College ____Unclassified/Other
Instructor Signature
ONLY REQUIRED FOR LATE ADD
Instructor Signature
ONLY REQUIRED FOR LATE ADD
TOTAL CREDIT HOURS REGISTERED FOR THIS TERM: BEFORE THIS ACTION _________ AFTER THIS ACTION________
Check here if this is a total withdrawal from class for this term □ Last Date of Attendance:_________________
(Date Required for Total Withdrawal from All Classes)
Reason for withdrawal: ____________________________________________________________________________
I understand that by signing this form that I, the student, am legally obligated to pay all tuition and fees. In the event of default, the University
may refer my account to a credit reporting agency, a collection agency, and/or initiate legal action to recover any outstanding
debt. I understand that I am also responsible for the costs of collection including interest, penalties, collection agency fees,
court costs and attorney fees.
Student Signature: __________________________________ Date: ____________________
Advisor Signature: __________________________________ Date: ____________________
Deans Office Signature: ______________________________ Date: ____________________ Office of the Registrar 6/2015
