Summer University Course Registration Form
Name
*
First
Last
Preferred Name
First
Last
Previous Name (if any)
First
Last
Date
*
MM slash DD slash YYYY
Date of Birth
*
MM slash DD slash YYYY
Email
*
Phone
*
Daytime Phone
Mailing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
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Arkansas
California
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Delaware
District of Columbia
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Northern Mariana Islands
Ohio
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Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Same Billing Address?
*
Yes
No
Billing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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?
*
Select one
U.S. Citizen or U.S. Naturalized
U.S. Dual Citizen
Other Non-U.S.
U.S. Permanent Resident
U.S. Refugee
U.S. Asylee
Are you currently an active duty member of the US Military?
Select one
No
Yes
Are you a veteran?
Select one
No
Yes
Are you a current high school student?
*
Select one
Yes
No
Are you an incoming first year student?
*
Select one
Yes
No
Have you previously taken a course at UMaine?
*
Select one
No
Yes
Last semester of attendance
*
Are you currently a student at a college or university other than UMaine?
*
Select one
No
Yes
Specify where
*
Have you previously completed a degree?
*
i.e. bachelors, masters, etc.
Yes
No
How did you hear about Summer University?
family, friend, or colleague
instructor
advisor
on-campus signage
radio
postcard
web ad
print ad
internet search engine
other
Additional information that might help with the registration process?
*
Yes
No
Enter Additional Information here.
*
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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Email
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Summer University Course Registration Form