Registration form for Fall semester 2009

Registration form with deposit must be returned immediately. All fees due by August 24, 2009

All students must complete the form. Tutoring assignments will not be made until form is completed.

Student's Name

Last Name      First Name   

Student email Address    MUID

Billing Name (Parent)  

Billing Address    Zip Code

Father's Work Phone Mother's Work Phone  

Home Telephone   Parents' e-mail Address

If REMEDIATION tutoring is required as a condition of your acceptance, it will be added to your tutoring hours. If you are a continuing student or a new student who wishes to take REMEDIATION tutoring, please enter the desired number of hours of REMEDIATION tutoring in the box.

DEPOSIT REQUIRED WITH FORM

$200 WV resident

$200 Metro

$300 Non-resident

Student is a financial aid recipient.

Student is a client of vocational rehabilitation.  Send copy of this form to VR counselor.

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We will observe this request whenever possible.