Non-Matriculated Undergraduate Student Registration Form
Entering Year:
Semester:
Spring
Spring Break
Summer
Fall
Winter Intersession
Enrollment Status:
Previously Registered
New Student
Personal Information
WCSU Banner ID No. (if applicable)
Gender
Male
Female
Prefix
Mr.
Mrs.
Miss
Ms.
Dr.
Race
American Indian
Asian
Black (Not of Hispanic Origin)
Hispanic
White
Other
First Name
MI
Last Name
Address Information
Number & Street
APT or Unit
City / Town
State
Zip Code
Phone Number (Home)
Phone Number (Mobile)
Email Address
Emergency Contact Name/Relationship
Emergency Contact Phone
Date of Birth
Veteran Status
Yes
No
Have you been in contact with the Office of Veteran Affairs?
Yes
No
Are you a Connecticut Resident?
Yes
No
Are you a citizen of the United States?
Yes
No
Education level to date
High School Diploma or Equivalent
A.S. Degree
Bachelors Degree
Master's Degree
Doctoral Degree
Course Information
I would like to register for the following courses (proof of prerequisites required with proper documentation (i.e. SAT/ACT scores, unofficial transcript, etc.):
Course 1
5-Digit CRN
Subject
Course No.
Section
Course 2
5-Digit CRN
Subject
Course No.
Section
Course 3
5-Digit CRN
Subject
Course No.
Section
Payment Information
All payments are due at the time of registration. WCSU accepts cash, check and debit/credit cards (Master Card, Visa, American Express and Discover)
All debit/credit card transactions must be made online at
www.wcsu.edu/ezpay
and are subject to a non-refundable 2.75%/$3 minimum convenience fee.
Non-attendance of classes does not entitle students to a refund on their tuition and fee bill, formal withdrawal is required. WCSU refund rules apply and rates are determined based on the date of withdrawal. For more information go to
www.wcsu.edu/cashiers/refund
. Course withdrawal policies are available online at
www.wcsu.edu/registrar
.
I
understand that when I register for any class at
Western Connecticut State University
or receive any service from
Western Connecticut State University
I accept full responsibility to pay all tuition, fees, and other associated costs, which may include, but is not limited to, housing, meals, fines, or incidental charges assessed as a result of my course/housing registration and/or receipt of services.
Collection Agency Fees:
I understand and accept that if I fail to pay my student account bill or any monies due and owing
Western Connecticut State University
by the scheduled due date, and fail to make acceptable payment arrangements to bring my account current,
Western Connecticut State University
may refer my delinquent account to a collection agency and the university may no longer accept direct payments. I further understand that I am responsible for paying the collection agency fee which may be based on a percentage at a maximum of fifteen percent (15%) of my delinquent account balance, together with all costs and expenses, including reasonable attorney’s fees, necessary for the collection of my delinquent account. Finally, I understand that my delinquent account may be reported to one or more of the national credit bureaus
I realize that by registering for these classes I will be held responsible for full payment of the above-listed courses in accordance with the terms outlined above. Please refer to the Cashier’s office for payment schedule
I acknowledge the statements above
Signature
Date
Contact Information