___ Full-time Undergraduate; __ Part-time Evening/Weekend; ___ Nursing/BSN;

___ Transient Student from another college; ___ Other _______________________________

PERSONAL DATA:

Name ___________________________________ Social Security #: _________________

Home Address ________________________________________________________________

City ________________________ State ______________ Zip _______________

OPTIONAL:

Marital Status: _________________ Race ______________ Birthdate ___________

Employer _____________________________________________________________________

Employer Address ______________________________________________________________

City ________________________ State ______________ Zip ________________

Home Phone (_____)____________________ Work Phone (_____)______________________

COURSE SELECTION (Please list complete course number and section)
 

Dept	Crs. No.	Sect.	Course Title	Cr.	Day/Time	Room/Bldg.

Will you require a dormitory room? ___ Yes ___ No

When? (dates) _________________________________________________________________

Have you previously enrolled at Ashland University? ___ Yes ___ No

When enrolled (term/year)? _______________________________________________________

TUITION PAYMENT PLANS
Payment by one of the following methods must accompany this registration. Registrations received without payment will not be processed. Payment Options (check one)

___ check

___ VISA Number ____________________________ expires _____________

___ MasterCard Number ____________________________ expires _____________

___ Discover Card Number __________________________________ expires ______________

___ Financial Aid

___ Corporate Reimbursement (complete section below)

Amount charged $ ___________________

Signature _______________________________________________ date _______________

CORPORATE REIMBURSEMENT POLICY Those students on corporate reimbursement may delay tuition payment until the end of the semester upon receiving grades. There is a $20 fee per course for this option. If your balance is not cleared within thirty (30) days after the release of grades, 1.5% per month will be charged on all outstanding balances. If you are not on full reimbursement, the portion for which you are responsible must be enclosed with your registration.

The above student is eligible for corporate reimbursement at:

___ Full Reimbursement ___ Partial Reimbursement (designated amount or % _______)

Authorizing Signature ___________________________________________________________

Title _________________________________________________ Date _______________

TEXTBOOKS
If mailed in advance, must be paid by credit card. ___Visa ___ Master Card

Number __________________________________________ expires ________________

___ Ship RPS ___ Pick up at AU Bookstore (419) 289-5301 or 800-547-1199 ___ Acquire elsewhere
 

Return completed form with tuition payment to Registrar's Office (Summer Registration), Ashland University, 401 College Ave., Ashland, OH 44805-3799 or Fax to 419-289-5939.

Questions????? regis@ashland.edu