Late Course Registration Form March 2015 printable pdf download

LATE COURSE REGISTRATION

Registrar’s Office, Davidson Hall, Room 116

Phone (860) 832-2236, Fax (860) 832-2250

Name: ________________________________

Student ID#: ____________________ Term / Year: ____________

NEW STUDENTS ONLY:

Street Address: __________________________________________________ Apartment #: ___________________

City: _____________________________________ State: ________________ Zip Code: ______________________

Home Phone: ____________________ Cellular Phone: _________________ Email: _________________________

Date of Birth: ___________________ Social Security Number (optional): ___________________

SEX:

US CITIZEN :

STATUS: 



Male

Graduate (previously obtained a Bachelor’s Degree or higher)



Female

Undergraduate

Are you or have you been a member of the U.S. Military? 



RACE:

THIS INFORMATION IS REQUESTED FOR STATISTICAL PURPOSES ONLY; RESPONSE IS OPTIONAL.

What is your ethnicity? (check one)  Hispanic or Latino

 Not Hispanic or Latino

What is your race? (mark one or more races to indicate what you consider yourself to be)

 American Indian or Alaskan Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander  White

COURSE INFORMATION

Department &

CRN

Section/Session

Title

Credits

Course Number

I understand that registering for classes at Central Connecticut State University generates charges that I am legally

obligated to pay in accordance with University payment deadlines and/or formal withdrawal policies. I also understand

that any unpaid financial obligation may be referred to the University's contracted collection agency and that I will be

responsible for any related collection costs in addition to the amount due.

STUDENT’S SIGNATURE: _____________________________________________DATE

: ______________________________

REQUIRED SIGNATURES:

_____________________

_________________________

Course Instructor:

Recommend Approval

Name

Signature and Date

Approval Not Recommended

_________________________________

__________________________________

Chair of Department offering course

or Chair’s official designee*:

Name

Signature and Date

*Any prerequisites or other course restrictions, including capacity, are waived for this student to allow for late registration

unless otherwise noted by the Department Chair in the space below.

Rev. 3/15

Late Course Registration Form March 2015

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