Year: 20____
Semester : Fall Winter Spring Summer
Submit to Registrar’s Office (123 White Hall) once all signatures are obtained.
Student’s Full Name
9-Digit Student ID#
Student’s Major
The above-named student is approved to register for the following Utica College course in a tutorial format:
3-Letter Course Prefix
3-Digit Course #
Credit Hour
Part of term
Course title exactly as listed in the Utica College catalog:
Will the tutorial rquire an ENGAGE shell? YES NO
Courses should be approved and added before the end of the drop/add period.
Faculty member responsible for course (PRINT):
ATTENTION: Student must read the below and sign the form, approving any charges associated with this course and agreeing to payment
information. Form may be submitted to the Registrar’s Office on paper, fax, or scanned and emailed. Then the Registrar’s Office may register the
student. Once the student is registered, s/he will be notified via e-mail.
The Registrar’s Office will notify me at my Utica College e-mail address of any problems with this registration. If I have a hold on my account,
I will not be registered for this tutorial. If adding this course will exceed my maximum hours, I will need to request an increase of my maximum
hours or drop a course.
I accept responsibility for ensuring that all courses for which I register are appropriate to my degree program and for the accuracy of all
information I submit to the College.
I accept responsibility for all charges incurred as a result of my registration and that charges and registration are available for viewing on Banner
If charges are incurred while attending and it should be necessary for Utica College to use a collection agency, which is subject to the Fair Debt
Collection Practices Act, I agree to pay all collection costs and attorney's fees.
In the event I qualify for Title IV federal funds, I authorize the College to use these funds to pay for all allowable charges beyond tuition, fees,
room and board. I understand that due to federal regulations, my financial aid package is based upon a minimum registration requirement after
drop/add period. If minimum requirements are not met, I will not be eligible for certain aid programs and will be responsible to pay any balance
in full prior to participating in future registration periods or the release of transcripts.
Traditional campus students who do not pay the balance in full will be automatically enrolled in a payment plan and charged a deferred payment
If I fail to meet payment arrangement deadlines, I will experience delays in finalizing my registration, I may be dropped from my courses, and if
applicable, may be removed from campus housing and have my meal plan canceled.
WITHDRAWING: I agree to notify the Registrar’s Office in writing of any withdrawal, or other change that affects my enrollment status in
any class or be subject to all charges. Academic deadlines are posted on the College website. Links are available from the Registrar’s home
page: www.utica.edu/registrar. If I withdraw after the deadline, I will be given a grade of WF, which will calculate as an “F” in my GPA.
Student’s Signature:
(Authorizing registration and agreeing to terms listed above):
Faculty Approvals (signatures):
Registration Completed: NOTE: If this is for a summer tutorial, a copy of this form must be sent to Student Financial Services.
Student emailed (date): and
Student registered (date):