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THIS REGISTRATION FORM IS INTENDED FOR USE BY STUDENTS WHO ARE NOT CURRENTLY ENROLLED IN KUTZTOWN UNIVERSITY.
Please see the Student Accounts 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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| Do you hold a degree from a 4-year school?
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If you checked yes, please contact Graduate Admissions to register as a Professional Credits Student.
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General Information:
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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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SSN |
(Optional)
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| Name of High School if currently attending:
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| Name of College/University if currently attending:
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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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Winter Session (Wed., Dec 16 – Thurs., Jan 14)
Please note: There is a six (6) credit maximum limit except for internships.
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