Graduate Enrollment Form

GRADUATE ENROLLMENT FORM

Use this form to apply for enrollment to the graduate program. Completion and signature constitute a binding agreement that the information provided is true and complete, that the applicant will comply with all applicable academic and financial policies of the institution, and that submission of this enrollment form authorizes the institution to obtain and verify academic records necessary to confirm eligibility for admission.

Student Information

Full Legal Name:

Date of Birth:   Student ID (if assigned):

Primary Phone:   Email:

Program and Enrollment

Degree Sought:

Intended Start Term:   Enrollment Status: Full-time Part-time

Mode of Delivery: On-campus Online / Hybrid

Prior Education

Degree Awarded:   Date Awarded:

Residency, Visa, and Funding

Residency Status: In-state Out-of-state International

International Students Only — Visa Type:   Proof of Funding Submitted: Yes

Tuition, Financial Aid, and Assistantships

Estimated Tuition and Fees for Initial Term:

Graduate Assistantship / Scholarship Awarded: Yes No

Emergency Contact & Medical Information

Emergency Contact Name:

Relationship:   Phone:

Policies, Certifications, and Authorizations

By signing this enrollment form, the student certifies that all information provided is accurate and complete. Enrollment is conditional upon verification of prior academic credentials and compliance with admission requirements. The student understands and accepts financial responsibility for tuition, fees, and any charges assessed to the student account. The institution may impose holds on registration and transcripts for unpaid balances; the student agrees that failure to satisfy financial obligations may delay or prevent continued enrollment.

The student acknowledges receipt of, and agrees to abide by, institutional academic policies including academic integrity, grading, and conduct standards. The student authorizes the institution to obtain and review transcripts, test scores, and other official records necessary to process this enrollment application and to verify eligibility. Submission of false or misleading information may result in denial of admission or rescission of admission or degree conferral.

The student consents to electronic communications for official notices, billing, and academic records in accordance with institutional policy and understands that certain notices may be provided electronically. The student may request reasonable accommodation for disabilities by contacting the appropriate office and providing supporting documentation.

Refunds and withdrawal: The student understands that withdrawal after the start of term may be subject to institutional refund schedules and that tuition and fee liability is determined by the date of official withdrawal. Questions about refund schedules should be directed to the Office of Student Accounts.

Acknowledgment: I have read, understand, and accept the terms and policies stated above. I affirm that the information contained in this form is true and complete to the best of my knowledge.

Optional: Supporting Documents

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