Fillable Graduate Enrollment Form printable pdf download

GRADUATE ENROLLMENT FORM

If at all possible, please enroll on line. Instructions can be found at:

STUDENT IDENTIFICATION NUMBER

PLEASE PRINT CLEARLY OR TYPE ALL INFORMATION



CHECK HERE IF YOUR ADDRESS HAS CHANGED

 MALE

LAST NAME

FIRST

MIDDLE DATE OF BIRTH (MM/DD/YYYY)

 FEMALE

HOME ADDRESS

STREET

APT.

EMAIL ADDRESS

 HOME

CITY

STATE

ZIP CODE

PHONE

 MOBILE

 FALL  WINTER  SPRING  SUMMER I  SUMMER II  YEAR TERM

SEMESTER:

20 ____

SPECIAL NOTES ABOUT ENROLLMENT



It is the student’s responsibility to drop/withdraw from an enrolled course. Non-attendance, for example, will not drop you from a course and you will still

be financially responsible for the course.



If tuition is being paid by a third party (sponsor, employer, etc.), and they do not pay, responsibility to pay falls to the student.



Enrollment into more than 12 credits requires the approval of the advisor and the Dean of Graduate Academics.



Initial Study Plans are due by the mid-point of the term. Failure to submit a Study Plan will result in not being allowed to enroll in subsequent terms.



The Application for Candidacy (A/C) is an absolute requirement for graduation.

If you are completing in the fall, your A/C must be submitted by October 1 in the term you that are completing the degree.

If you are completing in the spring, your A/C must be submitted by February 15 in the term you that are completing the degree.

COURSE NUMBER

SECTION

COURSE SECTION TITLE

INSTRUCTOR SIGNATURE

REASON FOR APPROVAL

CREDITS

EX: MGT 609

EX: A

EX: Project Management Fundamentals

(IF NEEDED)

(E.G., WAIVE PREREQ AND/OR CAP)

EX: 3

(INSTRUCTOR USE ONLY)

TOTAL

0.0

ONLY COMPLETE THIS SECTION IF YOU HAVE NOT PROVIDED THIS INFORMATION BEFORE.

If you have not provided your Social Security Number to Stevens before, it is not required, but strongly recommended that you do so. Please enter it in the Student Identification

Number box at the top of the form.

In conjunction with the Civil Rights Act of 1964 of the United States Department of Health, Education and Welfare, we are required to collect basic racial-ethnic information of

the student body at Stevens. This information is needed for many state and federal reports and it is held as confidential material and will not be released without your consent.

Only statistical data is released to government or any agencies. It is not mandatory for you to complete this section; however, we would appreciate your cooperation in

assembling this necessary data. Some Government funding, which Stevens receives, is based upon this data.

ETHNICITY:

RACE (CHOOSE ONE OR MORE):

 HISPANIC OR LATINO

 AMERICAN INDIAN OR ALASKA NATIVE

 NOT HISPANIC OR LATINO

 ASIAN

 BLACK OR AFRICAN-AMERICAN

 HAWAIIAN OR OTHER PACIFIC ISLANDER

 WHITE

STUDENT SIGNATURE (REQUIRED)

DATE