New Student Enrollment Form Template PDF

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Summary

Review Notes for Students in the Senior Years...

Description

Washburn University

CEP New Student Enrollment Form Student Information

1. Name: __________________________________________________________________________ Last

First

M.I.

Other Name(s)

2. Address: _______________________________________________________________________ Street

City

3. Phone: home (

State

) _________________________ cell (

Zip

) ___________________________

4. Student e-mail: __________________________________________________________________

Office Use Only Fall 20_______Spring 20_______ Admissions: Date received________________

5. Parent e-mail: ___________________________________________________________________

6. SSN/WIN: ______________________________________________________________________ 7. Gender*

Female

Male

Birth date*________________________________________

*This information which is marked with an asterisk is collected solely for statistical purposes. All qualified applicants will receiveconsideration without regard to age, ancestry, race, color, sex, religion, national origin, disability, parental status, or sexual orientation. The University is an equal opportunity institution.

-------------------------------------------------School Information---------------------------------------------------------------------------8. High School at which student is enrolled: ____________________________________________ 9. H.S. Cumulative GPA: ___________ Math ACT score*:___________ Anticipated Graduation Year: _________________ * Please note: Enrollment in MA 116 requires ACT math score of 22 or the equivalent score on the Accuplacer. Enrollment in MA 140 requires ACT math score of 25 or the equivalent score on the Accuplacer.

-------------------------------------------------Schedule Information------------------------------------------------------------------------10. Student Schedule: CRN

Department

Course #

Course Title

Credit Hours

Exceptionally qualified students may request approval below for enrollment in more than 6 hours.

It is expected that this student will succeed in an increased course load.

H.S. Official approval: ____________________________________________Date:______________

----------------------------------------------------- Consent Information ------------------------------------------------------------------11. Required Signatures: Student Signature___________________________________________________________________________________________Date:___________ Parent Signature___________________________________________________________________________________________ Date:____________

H.S. Principal/Counselor Signature______________________________________________________________________________Date:____________

-----------------------------------------------------Payment Information--------------------------------------------------------------------The tuition charge per credit hour is 1/2 of the Traditional Undergraduate rate or Business Undergraduate rate, if enrolling in Personal Finance. You may view current tuition rates and find instructions for various payment methods on the Business Office homepage: www.washburn.edu/business-office Once enrolled the student is financially obligated unless they submit a drop form, available through their high school counselor prior to the refund deadline. For more information on the Concurrent Enrollment Program, please visit www.washburn.edu/cep

Copies: White: University Yellow: High School Pink: Student

CEP doc revised 2-26-18...