Audit Registration Form

UW-Whitewater Audit Registration Form

To register for undergraduate audit credit, you must have graduated from high school or have earned the G.E.D. equivalent. To be eligible for graduate audit credit, a baccalaureate degree from an accredited college or university is required. Although graduate

students can take either undergraduate or graduate courses, undergraduates cannot enroll in graduate courses (numbered 500-700). Students registering under this option cannot change from audit to a traditional grade basis during the term of enrollment.

Print legibly and fill out all sections of this form. If a section does not apply to you, indicate N/A.

After you have completed the form and obtained the instructor signature(s), please return the form to the Registrar’s Office in Roseman no later than the first week of the term.

NAME________________________________________________________________________________________________________________

________________________________________________

Last

First

Middle Initial

7-digit UW-W ID number or Social Security Number

PERMANENT ADDRESS___________________________________________________________________________________________________________________________________________ _______________________

Street

City

State

Zip

County

TELEPHONE _______/_______/__________

E-mail __________________________________

COURSE REQUESTS:

Term:

1. _____________________________________________________________________

_______________________________________

______________________

__________________

___ (yr)

Fall

Class #

Subject Area

Course #

Sec #

Units

Course Title

Instructor

Location

____(yr)

Spring

Summer ____ (yr) 2. _______________________________________________________________________________

______________________________________________

_________________________

____________________

Class #

Subject Area

Course #

Sec #

Units

Course Title

Instructor

Location

BIOGRAPHIC:

Sex (Circle One)

Racial/Ethnic Heritage (Check those that apply )

Cuban

US VETERAN

US CITIZEN

Birthdate _______/_______/_________

1. Male

Cambodian

,

Puerto Rican

Yes

No

Yes

No

2. Female

Hmong

Black/African American

If yes,

Birthplace ______________________________________

Vietnamese

Other Asian

From _____ To _____

City

State

American Indian /Alaskan Native

Other Hispanic or Latino/a

Tribe _______________________

White

DISABILITY

SENIOR CITIZEN

RESIDENCY: A student must be a bona fide resident of Wisconsin (Wisconsin Statutes 36.27 (2)for a minimum of one year next to and preceding the term of

enrollment in order to be eligible to pay resident fees. In determining bona fide residency, filing state income tax returns, eligibility for voting in this state,

Yes

No

(60 & over)

Wisconsin motor vehicle registration, employment in Wisconsin, and self-support shall be considered. Do you claim legal Wisconsin residence for tuition?

Yes

No

Yes

No

How long have you lived in Wisconsin? ______ Years

From _____/_____/_____To _____/_____/______

RECEIVING SSDI/SSI

See Reverse side

BENEFITS

of this form

Current place of employment _________________________________________________________________ From ____/____/_____ To ____/_____/_____

Yes

No

ENROLLMENT LEVEL

Name

City

State

See Reverse side

Undergraduate

Previous place of employment ________________________________________________________________ From ____/____/______ To ____/____/______

Name

City

State

of this form

Graduate

UW-WHITEWATER ENROLLMENT:

Total number of units this term: _________ UNITS

Currently enrolled in a degree program at UW-Whitewater?

Yes

No

Have you previously taken courses at UW-W?

Yes

No

EDUCATION HISTORY:

List in chronological order any education: high school, also college, university, vocational-technical, extension programs, etc., and any degree(s) earned. Use back of form if more space is needed.

Name of School

City/State

From mo/yr to mo/yr

Degree

High School

Post Secondary

Student: I certify that the information above is correct and that I am obligated to pay tuition and fees according to the

Instructor(s): I consent to allow this student to audit my course(s) on a space available basis.

audit policy guidelines on the reverse side of this form.

________________________________________________________________________________________________________

Instructor signature for course request 1

Date

_________________________________________________________________________________________________________________________

____________________________________________________

Signature

Date

Instructor signature for course request 2

Date

Chair(s): I consent to allow this student to audit the course(s) on a space available basis.

Dean(s): I consent to allow this student to audit the course(s) on a space available basis.

________________________________________________________________________________________________________

__________________________________________________________________________________________________

FOR LATE

Chair signature for course request 1

Date

Dean signature for course request 1

Date

ADDS ONLY

____________________________________________________

__________________________________________________________________________________________________

Chair signature for course request 2

Date

Dean signature for course request 2

Date