CU ONLINE NON-CREDIT REGISTRATION              FALL, 2000

_______________________________________________________________________________________________ 
 Last Name                           First Name            Middle Initial                             Former Name, if applicable 
 

_______________________________________________________________________________________________ 
 Student/Social Security #                       Date of Birth                                                   EMAIL ADDRESS 
 

_______________________________________________________________________________________________ 
Mailing Address                                       City                                                   Zip       Day Time Phone
 
Ethnic Origins (Optional)

American Indian or Alaska Native ______

Black, not of Hispanic origin ______

Hispanic ______

Asian or Pacific Islander ______

White, not of Hispanic origin ______

Other ______
Gender

Male ______                                 Female ______

Citizenship

U.S. ______

Non U.S. Citizen ______

              Country of Citizenship __________________

              Visa Type __________________

ALL APPLICANTS: ANSWER ALL QUESTIONS

Do you have a high school diploma? Yes ____ No ____    Do you have a college degree? Yes ____No ____

If yes, please indicate name of College/University _________________________________________________

Have you ever enrolled for college courses at any campus of the of the University of Colorado?  Yes ____No ____

If so, at what campus: Denver __, Boulder __, Health Sciences __, Colorado Springs __, Extended Studies ___

If you are a male born after Dec. 31, 1959, the following selective service question must be answered to comply
with Colorado state law: Are you registered with the U.S. Selective Service? Yes ____No ____

Have you ever been convicted of a felony? Yes ____No ____

 
TITLE OF COURSE DEPARTMENT COURSE NO. INSTRUCTOR TUITION
1st Semester Latin Modern Languages NCLT 1010 Mary DeForest $250.00
Amount Paid ___________________________ Please put your SS# on your checks and mail to:

Patty Godbey, Assistant Director, CU Online 
University of Colorado at Denver, Campus Box 198
P.O. Box 173364
Denver, Colorado  80217-3364
303-556-5961 
 patty.godbey@cudenver.edu
 
YOU WILL NOT BE AUTOMATICALLY DROPPED FROM THESE COURSES 
FOR NON-PAYMENT OR NON ATTENDANCE

I  certify to the best of my knowledge that the information furnished on this application/registration is true and  complete without evasion or misrepresentation.  I understand that if  found to be otherwise, it is sufficient cause for rejection or dismissal.  I understand that admission to the University of Colorado as a non-degree student does not guarantee eligibility for regular degree status.  I understand that I am responsible for  these tuition fees. 

Please fax or mail this form along with your payment, (credit card #, check, or  money order) to: CU Online, University of Colorado at Denver, P.O. Box 173364, Campus Box 198, Denver, Colorado  80217
If you have any questions regarding your registration, please contact the CU Online office at 303-556-6505.

APPLICANTíS SIGNATURE:______________________________________________________________