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Northwestern University
Visiting Student
Registration Form
Summer 2013
TO AVOID DUPLICATION OF REGISTRATION AND BILLING, PLEASE DO NOT SUBMIT MORE THAN ONE COMPLETED REGISTRATION FORM.
PERSONAL INFORMATION
Name
(Last) (First) (Middle Initial)
Current email
Daytime phone Emergency phone
Current mailing address
(Street) (City) (Province/state and Postal code) (Country)
Permanent mailing address
(Street) (City) (Province/state and Postal code) (Country)
Gender: ___ Female ___Male Date of birth / /
(mm/dd/yyyy)
STUDENT TYPE (Students who have not graduated from high school may not register as visiting students.)
O Visiting Undergraduate student from (Home Institution)________________________________________________________
O Visiting Graduate student from ___________________________________________________________________________
(Institution)
O Have Undergraduate degree from another university and taking course for personal enrichment
O Currently employed professional educator (please complete the approval form below)
O Visiting international student (If you do not hold a current F-1 Visa, please fill out the International Visiting Student form.)
O Former Northwestern University student
o Who graduated in ___________ from ______________________________________school.
o Who did not complete a degree and last matriculated in _______quarter in the year_______.
CITIZENSHIP STATUS (required)
O U.S. citizen
O Naturalized
O Temporary U.S. resident; visa type_________________
O Permanent U.S. resident (not U.S. citizen), county of citizenship ____________________
RACE/ETHNICITY (optional)
Do you consider yourself to be Hispanic/Latino?
O Yes O No
In addition, please select one or more racial categories to describe yourself.
O American
Indian or
Alaskan Native
O Asian O Black or African
American
O Native Hawaiian
Pacific Islander
O White
2. Student name:
TUITION AND FEES
O Tuition per course: $3,615 (Certified Secondary Education Teacher*)
O Tuition deposit per course: $250 (non-refundable)
O Registration fee: $50 (one-time, non-refundable)
Minimum payment due at registration: $250 non-refundable tuition deposit per course plus $50 registration fee.
(Tuition in full may be paid at time of registration. The above amount states minimum due.)
REGISTRATION
Please use the sample below as a guide and indicate the courses in which you wish to be registered.
DEPARTMENT COURSE
NUMBER
SECTION
NUMBER
TITLE TUITION/FEE/DEPOSIT
($3,615 per course)
SAMPLE
Psychology
SAMPLE
110-0
SAMPLE
26
SAMPLE
Introduction to Psychology
$3,615 or $250
(full tuition or non-refundable
tuition deposit per course)
1.
2
3.
If you selected Physics 130-1, -2, or -3 or 135-1, -2, or -3, you
must choose a section of the corresponding non-credit, no fee
lab (Physics 136-1. -2 or -3). These labs meet approximately 3
times per week on a rotating schedule; specific meeting dates
are provided on the first day of class. Afternoon labs fill
extremely early and may not be available after the first week of
registration (April 2-6).
TOTAL AMOUNT OF TUITION AND FEES FOR
ALL COURSES
REGISTRATION FEE (ONE TIME, NON-
REFUNDABLE)
$50
TOTAL AMOUNT ENCLOSED
* Certified Secondary Education Teachers may be eligible for a reduced tuition rate. Please complete the third page of this form.
**Non-refundable deposits are accepted on or before June 17 and must accompany this form. The Office of Student Accounts will issue a bill for the balance due.
Students will be charged a 2.75% processing fee for all credit card payments on the balance due. Registrations submitted after June 17 must include full payment of
tuition, plus applicable fees.
PAYMENT METHODS – SELECT ONE
CHECK OR MONEY ORDERS
O Check or money order payable to Northwestern University attached. Checks must be drawn on a U.S.
bank in U.S. dollars. (Please include student name on check or money order.)
CREDIT CARD
O I hereby authorize Northwestern University to charge $ ___________________ to my
o MasterCard o American Express (Note: Northwestern University does not accept VISA as payment.)
Card number Expiration Date Cardholder’s Signature
SUMBIT REGISTRATION AND PAYMENT
I acknowledge that I may make changes to my registration until June 23, 2013 without incurring additional fees, and that any adds, drops or
withdrawals must be made in writing and submitted to the SCS Registrar only. I have read the refund provisions in the Summer Session Change of
Registration Policy available at www.northwestern.edu/summernu/adds_drops/ and acknowledge that I may not receive a 100% refund if I drop a
class or withdraw from Summer Session, as set forth in the Policy.
Student’s signature (REQUIRED) Date
IN PERSON IN PERSON OR BY MAIL BY FAX (CREDIT CARD PAYMENT ONLY)
Summer Session
School of Continuing Studies
405 Church Street
Evanston, Illinois 60208-4220
SCS Registrar
School of Continuing Studies
Wieboldt Hall Room 612
339 East Chicago Avenue
Chicago, Illinois 60611-3008
312-503-4727 (Please email
onlinereg@northwestern.edu to confirm receipt of
your registration form.)
3. Student name:
APPROVAL FORM for CERTIFIED SECONDARY EDUCATION TEACHERS
Certified Secondary Education teachers that were employed full-time during the past year and are enrolled in courses
with their employer’s recommendation may be eligible to receive the reduced tuition rate of $1,560. You are
responsible for payment of any deposits or fees at the time of registration. This form must be complete at the time of
registration for you to be considered for the reduced tuition rate.
TO BE COMPLETED BY APPLICANT
Name:
(Last) (First)
Institution Current position
Business phone Business fax
Business address
(Street)
(City) (State/Province) (Zip/Postal Code) Country
TO BE COMPLETED BY EMPLOYER
I certify that _____________________________________________ is currently employed full-time at the institution
named above and recommend him or her for the Summer Session reduced tuition rate for Certified Secondary
Education Teachers.
Supervisor’s name (please print) Title
Supervisor’s signature Date Phone number
