Winter 2013/2014 Registration Form for NON-KU Undergraduate Students


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.

 

General Information:

Social Security Number
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.
 
First Name Middle Initial
Last Name Maiden Name
Street Address 1
Street Address 2
City    State    Zip Code
County `
Email Address
Home Phone Cell Phone
Date of Birth:       Gender
PA Resident
 
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.
What is your ethnicity?
What is your race? (Mark one or more races to indicate what you consider yourself to be.)
 



 

Emergency Contact Information:

First Name Last Name
Phone Relationship
 

Winter 2013/2014 Session (Mon., Dec 16 – Wed., Jan 15)

Please note: there is a six (6) credit maximum per session except for internships.

Department Course
Number
Section
Number
Course
Title
Credits