Non-Matriculated Student Registration Form This form must be completed by anyone who wishes to register for a Graduate course at Emmanuel College prior to formal acceptance into a degree or certificate program. This form must be submitted at least 2 weeks prior to the start date of the session in which you are enrolling. Please complete this form in its entirety.
1. I am registering for a course in the following session:
○ Fall 1 20____ ○ Fall 2 20____
○ Spring 1 20____ ○ Spring 2 20____
○ Summer 1 20____ ○ Summer 2 20____
2. Current Contact Information: ____________________________________________________________________________ Last Name First Name Middle/Maiden Name ____________________________________________________________________ Home Address _____________________________________________________________________ City State Zip Social Security Number: ______________________________ Home E-mail Address: __________________________________________________ Home Phone: ______________________________
Cell Phone: ________________________________
Date of Birth: ____ /____ /_____ Gender (circle one):
Male / Female
3. Emergency Contact Information: _______________________________________________________________________________________ Person to notify in case of emergency Relationship Phone Number
4. Previous Education: List the name of the institution from which you earned your Bachelor’s degree and your date of graduation. You will need to submit proof of degree conferral from this institution (either an official transcript or unofficial transcript is acceptable) prior to registration. Please do not use abbreviations or acronyms for school names. Name of Institution
Degree Date
1
5. Registration Information: Course Course Location Prefix Number Samples
RAC
9016
Boston
HRM
9028
Online
Title of Course
Financial Management for Sponsored Programs Managing Diversity in Contemporary Organizations
Day
Time
Wednesday 6-10pm N/A
N/A
List Your Course Selection Here
6. How did you hear about Emmanuel College? _____________________________________________________________ 7. Do you intend to enroll in a degree or certificate program at Emmanuel College after completing this course (circle one)? Yes No Unsure 8. Demographic Information (optional): Are you Hispanic/Latino (including Spain)? o Yes o No Ethnic Origin (select one): o American Indian or Alaska Native (including all Original Peoples of the Americas) o Asian (including Indian subcontinent and Philippines) o Black or African American (including Africa and Caribbean) o Native Hawaiian or Other Pacific Islander (Original Peoples) o White (including Middle Eastern) 9. Certification of Information: I acknowledge that, by submitting this form, I am fully responsible for tuition payment. I will refer to the Emmanuel College Academic Catalog with any questions about policies and procedures. I understand that this is a registration form for 1 graduate course at Emmanuel College. I recognize that I may take a maximum of 2 courses as a non-matriculated student and that if I intend to continue on in the program, I must complete an application and become a fully accepted/matriculated student. By submitting this form, I agree to the above. _____________________________________________________________________________ Signature Date 2