New Student Undergraduate Nondegree Application/Registration Form

New Student Undergraduate Nondegree Application/Registration Form

For academic advising, call the University College, (937) 775-5750.
Return to the Office of the Registrar

A $10 application fee will be assessed with other fees.

_____-_____-_______ Social Security number	Indicate quarter you wish to register __ Fall __ Winter __ Spring __ Summer
You must be a degree student to qualify for federal student financial aid programs.

___________________________________________________________________
Last name	First name	Middle name	Maiden name

___________________________________________
Street address
___________________________________________
City State/Zip
___________________________________________
Home phone Business phone

__ Male __ Female __ Married __ Unmarried

County: check off or enter Ohio county
__ Montgomery
__ Greene
__ Clark
__ Miami
__ Mercer
__ ________________

_________________________
Month/day/year of birth

This information is required by the federal government; however, reporting it on this
form is strictly voluntary.)

Ethnicity: (choose one)	__ Hispanic/Latino	__ Non-Hispanic/Non-Latino
Race: (choose one or more)	__ Asian	__ Black/African American
__ American Indian/Alaskan Native	__ White	__ Native Hawaiian/Other Pacific Islander

Educational Information:
Have you ever attended Wright State University? __ Yes __ No
___________________________________________________________________
High school attended City/State Year of graduation
___________________________________________________________________
Last college attended/College awarding degree City/State Degree awarded and year earned

___ Yes ___ No Was cumulative grade point average above 2.0 on a 4.0 point scale at your last college attended?
If not, you must contact the Office of Admissions before you register.

Resident/Nonresident Information U.S. citizen? __ Yes __ No
If not a citizen, what visa? ______________________

For the purpose of determining fees, students are classified as Ohio or non-Ohio residents. Please check one of the following which applies to your residency status.

__ Yes, I reside and am gainfully employed on a self-sustaining basis in Ohio and wish to pursue a part-time program.
__ Yes, I am on active duty in the United States military service and am stationed and residing in Ohio, or I am a dependent of such a person.
__ Yes, I have lived in Ohio for at least 12 consecutive months prior to this enrollment and am not receiving financial support from non-Ohio residents.
__ Yes, I am a dependent student with at least one parent or guardian residing in Ohio for at least 12 consecutive months prior to this enrollment.

By signing this agreement with Wright State University, I am requesting to be registered for classes and promise to assume financial responsibility for the payment of all my education-related charges and fees associated with my student account and to pay those charges when due. In the event my account becomes past due, I acknowledge that a registration and transcript hold will be placed on my account and my account may be reported to the credit bureau and referred to the State of Ohio Attorney General's Office for collection. I agree to pay all late fees, collection cosots, and attorney fees related to the collection of my account.

____________________________________________________________________

Signature

Date

Please indicate with an (x) if you do not want
___ to be billed for student insurance (during early registration)

Enter Preferred Classes

Line no.	Dept.	Course number	Section number	Credits	Repeat-R* Audit-A*
1
2
3
4
5
6

*If applicable, enter R for Repeat or A for Audit.

Students are encouraged to select alternate classes. The alternate classes will be used only if the preferred classes are closed.
Enter alternate classes with corresponding line number

Alt. for Line no.	Dept.	Course number	Section number	Credits	Repeat-R* Audit-A*

Ohio law requires that non-resident fees be assessed to male Ohio students who are between the ages of 18 and 25 and have not registered with Selective Service.