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THIS REGISTRATION FORM IS INTENDED FOR USE BY STUDENTS WHO ARE NOT CURRENTLY ENROLLED IN KUTZTOWN UNIVERSITY.
Please see the Bursar's page for Tuition, Fees, and Payment information. Registration and course enrollment is NOT complete until
payment is made in full. You will receive additional information (including account information) and instructions on how to make payment.
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General Information:
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Social Security Number
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Mandatory disclosure of your social security number (SSN) is required for course
registration. The University will use the SSN to verify identity only, and will
not disclose or use it as a permanent student identifier, or any other reason.
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First Name
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Middle Initial
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Last Name
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Maiden Name
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Street Address 1
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Street Address 2
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City
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State
Zip Code
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County
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Email Address
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Home Phone
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Cell Phone
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Date of Birth:
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Gender
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PA Resident
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Kutztown University is committed to assuring equal opportunity to all persons regardless
of race, color, religion, national origin, ancestry or gender. This policy extends
to employment within and admission to the University and is compliance with all
federal laws, including Title IX of the Educational Amendments of 1972.
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What is your ethnicity?
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What is your race? (Mark one or more races to indicate what you consider yourself
to be.)
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Emergency Contact Information:
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First Name
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Last Name
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Phone
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Relationship
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Summer Session I 2014 (Wed., May 28 – Thurs., June 26) and
10 Week Session (see course description for begin/end dates)
Please note: there is a nine (9) credit maximum per session except for internships.
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Housing
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Meal Plan
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Summer Session II 2014 (Mon., July 7 – Thurs., Aug. 7)
Please note: there is a nine (9) credit maximum per session except for internships.
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Housing
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Meal Plan
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