Fillable Printable High School Enrollment Form - University of Alaska Fairbanks

High School Enrollment Form - University of Alaska Fairbanks

HIGH SCHOOL ENROLLMENT FORM

RECEIVED

Oce use only

OFFICE OF ADMISSIONS & THE REGISTRAR l PO BOX 757480, FAIRBANKS, AK 99775-7480 TEL: l 907-474-7500 / 800-478-1823 l FAX: 907-474-7097

Page of

SID label

oce use only

Barcode label

Oce use only

NAME: UA ID (or SSN):

(Last) (First) (M I)

SEMESTER OF ENROLLMENT: Year 20_____  Fall  Spring  Summer Date of Birth (MM/DD/YYYY):

CURRENT MAILING ADDRESS: Day Phone:

Evening Phone:

Email Address:

(City) (State) (Zip)

Residency

: Students seeking Alaskan residency or a waiver of non-resident surcharge must complete an “Applicaon for Resident

Tuion” or “Waiver of Non-Resident Surcharge” and provide required documentaon to the Oce of Admissions before the published

rst day of instrucon (UA Board of Regents RegulaonR05.10.05). See reverse side for informaon.

DEMOGRAPHIC INFORMATION: See reverse side for informaon and codes.

Sex:  Male  Female Ethnicity

: Vet/Military Status

For instrucons on withholding directory informaon, please see FERPA on reverse side

US Cizen?  Yes  No If no, Naon of birth: Naon of cizenship:

Visa Type: Permanent Resident?  Yes  No

PRIOR EDUCATION INFORMATION:

Name of high school you are aending: Locaon (city/state):

Expected graduaon date? (MM/DD/YYYY):

COURSE INFORMATION (Complete all informaon requested below. Refer to the Class Schedule for course informaon)

CRN Dept. Course

Number

Secon Course Title # of

Credits

“Yes”

Audit

Instructor Signature required

(permissions rec’d thru UAF e-mail account

from instructor or dept head is acceptable)

I understand I, or my parent, are responsible for all applicable UAF academic regulaons, tuion and fees whether or not I successfully complete

the course or courses in which I am enrolling

. The university will not iniate a drop for non-payment

Student’s Signature: Date:

Parent’s Signature: Date:

OFFICE OF ADMISSIONS AND THE REGISTRAR ONLY:

Processed By: Date:

To enroll at UAF while sll a high school student, you must

l Complete this form.

l Meet prerequisites of the course or courses in which you

want to enroll.

l Get permission from the instructor or the department

head.

l Submit the completed form to the Oce of Admissions

and the Registrar during the regular registraon period

l Pay tuion and fees by the last day of fee payment in the

semester you are enrolled. NOTE: Permission to enroll in

a course must be obtained each me you register.

l If you want to use university credit to meet high school

requirements, contact your high school counselor before

you enroll at UAF.

l Students may choose not to release their directory

informaon by compleng a “request to withhold or

release directory informaon” form, available at the

Oce of Admissions and the Registrar.*

11/11 M:\Forms\Working Folder\Forms 2010

Term ____________

RESIDENT AND NON-RESIDENT TUITION

First-me non-degree students or students returning to

enrollment aer more than a two-year absence are considered

non-residents unl they submit an “Applicaon

for Resident Tuion” with this registraon form before

the rst published day of instrucon and are approved

(for the purposes of residency pursuant to UA Board of

Regents Regulaon R05.10.05) as a resident of Alaska.

For more specic criteria, please refer to the “UA

Applicaon for Resident Tuion Assessment” at

www.uaf.edu/admissions/pdf/res_tuion_app.pdf.

ETHNICITY*

Code Descripon

AA Alaska Aleut

AE Alaska Eskimo, other

AH Alaska Indian, Haida

AI Alaska Indian, Other

AK Alaska Indian, Tlingit

AM Alaska Indian, Tsimpshian

AN Alaska Nave, Other

AQ Alaska Eskimo, Inupiaq

AS Alaska Nave, Southeast

AT Alaska Indian, Athabascan

AY Alaska Eskimo, Yup’ik

BL Black, Non-Hispanic

HI Hispanic

IN American Indian (Not Alaska Nave)

OT Other

PI Asian, Pacic Islander

WH White

XX American Indian or Alaska Nave

* Requested for compliance with Title IV of the Civil Rights

Act of 1964

VETERAN/MILITARY STATUS

Code Descripon

Blank Non-veteran

AA Acve Duty – Army

AC Acve Duty – Coast Guard

AF Acve Duty – Air Force

AN Acve Duty – Navy/Marines

AO Acve Duty – Other

DC Dependent Child

DS Dependent Spouse

VR Veteran – Discharged/Rered (Eligible)

WW Widow/Widower

INFORMATION RELEASE/FERPA

The Oce of Admissions and the Registrar is responsible

for keeping student educaon records. The full copy

of the university’s policies regarding access to student

records under the Family Educaonal Rights and Privacy

Act of 1974 (FERPA) are available at

www.uaf.edu/reg/ferpa/.

Directory Information

The university may release certain directory informaon

to the public on a roune basis unless a student requests,

in wring, that the university not release it. Forms to

request that directory informaon not be released are

available in the Oce of Admissions and the Registrar.

No directory informaon will be released unl the last

day of late registraon. Any request to withhold directory

informaon will connue unl a student provides

permission, in wring, for the university to release such.

Aer that, informaon will be released when appropriate.

The names of students who have requested their directory

informaon be withheld will not appear in the published

university chancellor’s and dean’s lists.

The following is considered directory informaon:

1. Name

2. E-mail address

3. Home city and state

4. Weight and height of students on athlec teams

5. Dates of aendance at UAF

6. Program/major eld(s) of study

7. Degrees and cercates received, including dates

8. Parcipaon in ocially recognized university

acvies

9. Academic and co-curricular honors, awards and

scholarships received, including dates

LATE PAYMENT/REINSTATEMENT FEES

Cost: $100; $35 per month for late payment plan payments.

Who pays: All students who have missed the fee payment

deadline and have a balance of $100 or more. An addional

$100 fee will be added to accounts which are not paid by the

withdrawal deadline. The university will not iniate a drop for

non-payment.

What’s covered: Processing of late payments

Contact the Business Oce (474-7384).

Oce of Admissions and the Registrar, 102 Signers’ Hall,

PO Box 757480, Fairbanks, Alaska 99775

907-474-7500 (ph) • 907-474-7097 (fax) • registrar@uaf.edu