Free Class Enrollment Form Template PDF Details

Are you looking for a free class enrollment form template? Look no further! This template is easy to use and can be customized to fit your specific needs. Simply download the template, fill in the information, and print out! Whether you are enrolling a new student or tracking attendance, this form will make the process quick and easy.

Below is some data that may be useful if you are looking to find out how much time it will require you to fill out free class enrollment form template and the number of PDF pages it includes.

QuestionAnswer
Form NameFree Class Enrollment Form Template
Form Length2 pages
Fillable?Yes
Fillable fields112
Avg. time to fill out22 min 58 sec
Other namesblank enrollment forms, course enrollment form template, google forms for online course registration, course registration form template word

Form Preview Example

ENROLLMENT FORM

Print legibly in ink in block letters

Mail to: B20 Day Hall, Ithaca, NY 14853-2801

q Spring 20 ___

q Summer 20 ___

q Fall 20 ___

q Winter 20 ___

q Cornell employee

q EDP participant (Summer/Winter only)

 

 

 

 

 

 

1.Biographical Information Cornell ID number:_______________________ Social Security number (optional):_________________________________

Name:___________________________________________________________________________________________________________________________________

last name

first name

middle name

suffix (Jr., III, etc.)

Date of birth:___________________________ Sex: o Male

o Female

E-mail address:__________________________________________________________

month / day / year

 

 

 

Home address:____________________________________________________________________________________________________________________________

street

city

state / province / country

zip / postal code

Home phone:_ _____________________________________________________Cell phone:_____________________________________________________________

area code / country code

area code / country code

To expedite communication of important information (such as your NetID), may we send occasional text messages to your cell phone?* o Yes o No *If yes, depending on your phone plan, you may be charged for these messages.

for office use only

___________

state

Note: Please enter your address and emergency contact information in the student self-service center at studentessentials.cornell.edu.

Have you ever studied at Cornell? o Yes o No Your name when last registered, if different:_________________________ Last term attended:_____________

date

Do you hold a bachelor’s degree from any institution? o Yes o No If yes, from which institution?___________________________________________________

 

name

city / state / province (and country if not U.S.)

 

Are you a U.S. Armed Services veteran? o Yes o No Are you a New York State

o resident or o non-resident?

2. Demographic Information

 

 

 

Are you a o U.S. citizen or o dual U.S. citizen or o U.S. permanent resident or o other citizenship?_ ____________________________________________

list your country of residence Optional: Select one or more of the following ethnicities that best describe you: Are you Hispanic / Latino (including Spain)?* o Yes o No

oAmerican Indian or Alaska Native (including all Original Peoples of the Americas)* o Asian (including Indian subcontinent and Philippines)*

oBlack or African American (including Africa and Caribbean)* o Native Hawaiian or Other Pacific Islander (Original Peoples)*

oWhite (including Middle Eastern)* *Please specify:___________________________________________________________________________________________

 

3. Course Enrollment

 

 

Winter Session and Part-Time Study students must submit their tuition and fees in full when they turn in this form.

 

 

 

Will class(es) be on the Ithaca campus? o Yes o No

 

 

 

 

 

 

Department

Course

Class

 

Class

Class

Credit

Grade

 

_________________ (not required for summer or winter registration) ________________

 

number

section

component

number

hours

option

 

 

FILM

3250

001

 

LEC

1109

3

L Animation History & Practice Course Instructor✝✝

Registrar

✝✝✝

 

 

 

 

 

 

 

 

 

 

 

Title

 

Instructor’s signature or Dept. stamp

College registrar’s signature

 

 

(1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

Instructor’s signature or Dept. stamp✝✝

College registrar’s signature✝✝✝

(2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

Instructor’s signature or Dept. stamp✝✝

College registrar’s signature✝✝✝

(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

Instructor’s signature or Dept. stamp✝✝

College registrar’s signature✝✝✝

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

Instructor’s signature or Dept. stamp✝✝

College registrar’s signature✝✝✝

 

 

 

 

 

 

 

 

 

Grade options: L = letter grade; S = satisfactory/unsatisfactory; V = audit

 

Image release (please check one):

 

 

 

✝ ✝

The College of Arts and Sciences requires only the department’s stamp.

 

q I grant permission q I withhold permission

 

 

 

 

 

All other colleges require either the instructor’s or the registrar’s signature.

 

for Cornell University to use my likeness, image, and/or voice in

 

 

✝ ✝ ✝

Required only for courses in

 

 

 

 

promotional, informational, or other materials.

 

 

 

 

 

 

 

By my signature I recognize my responsibility to read, understand,

 

 

• the Johnson Graduate School of Management (106 Sage Hall),

 

 

 

• the Law School (162 Myron Taylor Hall),

 

 

 

and abide by the rules and procedures at sce.cornell.edu/scepolicies

 

 

• the School of Industrial and Labor Relations (101 Ives West).

 

and on the Cornell University Policy Office website. I further agree

 

 

 

 

 

 

 

 

 

 

 

to be bound by, and recognize that I will not be exempted from, the

 

 

 

 

 

 

 

 

 

 

 

requirements of those rules and procedures because of ignorance,

 

New York State law requires on-campus registrants taking six or more credits

 

negligence, illness, other personal factors, or contradictory advice

 

to meet immunization laws. For details see sce.cornell.edu or e-mail

 

from any source.

 

 

 

 

immunization@cornell.edu. In addition, every non-matriculated Cornell

 

 

 

 

 

 

student must complete a Health History Form, available through the “Health”

 

 

 

 

 

 

page on the Summer Session, Winter Session, and Part-Time Study websites.

 

Signature

Date

 

 

 

 

 

 

 

 

___________

ck#

___________

amt

___________

date

___________

init

oHF

4. Cornell Employees

Cornell employees must also complete and submit the back of this form.

0317

For Cornell Employees Only

Please have this section completed by your supervisor and department head.

College or division:_ ___________________________________________________________________________________________________________

Employee’s job title: ______________________________________ Employee’s work phone:_ ______________________________________________

qStatutory employee

qEndowed employee

qRegular full-time employee

qRegular part-time employee

qEmployee on layoff*

qRetired employee*

The following information is requested for IRS reporting purposes only. (Enrollment in courses through the School of Continuing Education and Summer Sessions may have tax implications. Staff members should consult with the University Human Resource Services or their tax advisor.)

qThis course serves to maintain or improve current job skills.

qThis course does not serve to maintain or improve current job skills.

*If you are on layoff or retired: You do not need to obtain supervisors’, department heads’, or Benefit Service representatives’ signatures below as the Continuing Education office will obtain these for you.

Supervisor’s signature: _____________________________________________________________________ Date: _____________________________

Department head’s signature: _ ______________________________________________________________ Date: _____________________________

The following procedures, rules, and regulations apply to full- or part-time Cornell employees or temporary Cornell employees who are eligible for benefits. Employees are also responsible for reading and abiding by the rules and regulations on the School of Continuing Education and Summer Sessions website at sce.cornell.edu.

Eligibility

Regular full- or part-time non-academic and non-professorial academic (do not have faculty voting status) Cornell employees or temporary Cornell employees who are eligible for benefits may enroll in courses for credit or audit on a space-available basis, with the permission of their supervisor and department head. Supervisors have the authority to refuse to grant permission for the employee to take courses when job responsibilities require full-time attendance during regular working hours. Employees are eligible to take only those courses that are offered for credit, excluding most special programs. Questions about eligibility should be directed to Benefit Services at 607.255.3936 or e-mail benefits@cornell.edu.

Employees who register for six or more credits must meet the New York State immunization requirements (see parttimestudy.cornell.edu).

Tuition and Course Fees

Waived Tuition: If eligible, a regular full- or part-time employee or temporary Cornell employee may take up to four credits per semester of University course offerings without charge for tuition as long as s/he remains in good standing as an employee. A new employee must have started working before the beginning of an academic term or session to be eligible for waived tuition in a course taken during that period. Tuition may not be waived if an employee drops a course without notifying the School of Continuing Education and Summer Sessions by the first day of class.

Full Tuition: Employees must pay full tuition for coursework in excess of four credits per semester. Also, a person who terminates employment while taking a course for which tuition has been waived must either withdraw from the course within the time limits stated on the School of Continuing Education and Summer Sessions website or pay the full tuition charge. An exception to this provision may be granted if less than 25% of the instruction period remains at the time of termination.

Course Fees: All employees will be billed and must pay for course fees.

Making Up Time

Supervisors may either grant employees release time for time missed from work to attend class, or require that all time be made up when the absence from work interferes with the department’s operational requirements. In cases where the supervisor has requested that a course be taken, employees are not required to make up the time. Part-time employees are expected to take courses outside of regular working hours. Employees must make up all time off for coursework in excess of four credits per semester. All assigned homework must be done on the employee’s own time.

Dropping Courses and Withdrawal

Dropping a An employee who decides to drop or add courses must comply with the regulations indicated on the School of Continuing

Course: Education and Summer Sessions website at sce.cornell.edu.

Course An employee who decides not to take any courses for which she or he has registered must immediately complete a

Withdrawal: Change-in-Enrollment form and return it to the Continuing Education office in B20 Day Hall. An employee who fails to do so will receive an “F” grade and will be liable for tuition.

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completing class registration template stage 1

Fill out the Classsectioncomponent, Classnumber, Coursenumber, Class, and Registrar areas with any details that will be requested by the program.

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The program will demand you to give particular important info to automatically submit the part SignatureDate, and ckamtdateinitoHF.

class registration template SignatureDate, and ckamtdateinitoHF blanks to complete

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step 4 to finishing class registration template

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