Summer University Course Registration Form - Summer University

Name*

First Last

Preferred Name

First Last

Previous Name (if any)

First Last

Date*

Date of Birth*

Email*

Phone*

Daytime Phone

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Same Billing Address?*

Yes
No

Billing Address*

Street Address Address Line 2 City State ZIP Code

How long have you lived in the state of Maine for non-educational purposes? Enter 0 if you are not a Maine resident.*

Years	Months

What is your citizen type?*

Are you currently an active duty member of the US Military?

Are you a veteran?

Are you a current high school student?*

Are you an incoming first year student?*

Have you previously taken a course at UMaine?*

Last semester of attendance*

Are you currently a student at a college or university other than UMaine?*

Specify where*

Have you previously completed a degree?*

How did you hear about Summer University?

Additional information that might help with the registration process?*

Yes
No

Course Registration:

Campus*

University of Maine
UMaine Machias

Course Code*

Class Number*

Section Number*

Title of Course*

Credit Hours*

Grading Option*

Grade
Pass/Fail
Audit

Add a second course?*

No
Yes

Add course #2:

Course Code*

Class Number*

Section Number*

Title of Course*

Credit Hours*

Grading Option*

Grade
Pass/Fail
Audit

Add a third course?*

No
Yes

Add course #3:

Course Code*

Class Number*

Section Number*

Title of Course*

Credit Hours*

Grading Option*

Grade
Pass/Fail
Audit

In complying with the letter and the spirit of the applicable laws and in pursuing its own goals of pluralism, the University of Maine shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, national origin or citizen status, age, disability, or veterans status in employment, education, and all other areas of the University. The University provides reasonable accommodations to qualified individuals with disabilities upon request. An invoice will be mailed to you once your registration has been processed.

Applicant Signature*

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Name

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