Application

Off-Campus Credit Studies

Mail this form to:

Off-Campus Credit Studies
CB# 1020 The Friday Center
The University of North Carolina at Chapel Hill
Chapel Hill NC 27599-1020
Phone: 919-966-3587
Fax: 919-962-5549

Print out and complete this form to register.
Type or print your answers. Submit completed form to the above address.

Term of enrollment:
Fall _________ (fill in year)
Spring _________ (fill in year)
1st summer session _________ (fill in year)
2nd summer session _________ (fill in year)

PID (if unknown, use Social Security number): ___________________________
Disclosure of your Social Security number is purely voluntary. It will be used for administrative purposes only. If you do not disclose your Social Security number, you will be assigned an identification number. Name:

Last _________________________ First ______________ Middle _______________ Suffix _____

Date of Birth: _____________________________________

Gender: ____Male ____Female

Race: (For demographic purposes only)_________________________________

E-mail address (please print legibly):_______________________________________

Street address:________________________________________________________

City:_____________________________________ State:________ Zip:___________

County (NC residents only):_________________________________

Country:_________________________________________________

Daytime phone:_______________________________

Former name, if applicable:
Last _________________________ First ______________ Middle _______________ Suffix _____

Salutation (check one): Mr. ____| Ms. ____| Miss ____| Mrs. ____| Dr. ____|

Your highest earned degree:
Associate___| Bachelor's___| Master's___| Doctorate___| Other (specify):______________

Please list the course(s) you want for this term:

Course name and # GEOL 601
Section # 982 Credit hrs 3

Course name and # GEOL 602
Section # 982 Credit hrs 3

Payment
Tuition is to be paid to the University Cashier at Bynum Hall. For students registering on or before the first day of classes, you will be charged a $20 late registration fee. The Cashier's Office charges a $7.00 registration fee during spring and fall semesters and a nominal fee during summer terms.

The University Cashier accepts cash (do not mail), check, or money order. To pay by Mastercard or Diners Club, you may log on to studentcentral.unc.edu. Go to the Cashier Services section and click the Go button beside the "pay your bill" statement. Or you may mail your payment to CB #1400 Bynum Hall, Chapel Hill NC 27599-1400.

If you decide to make your payment with a credit card, a nonrefundable transaction fee will be added to your bill to cover the cost of providing credit card services. The transaction fee is currently 2 percent of the total charge and is subject to change if there is a change in the cost of providing the credit card service. Note: All payments must be processed by the University Cashier’s Office. Do not send checks or credit card numbers to the Friday Center for Continuing Education.

For more details on paying your tuition, current rates, and fees, visit the Cashier’s Office Web site or call 919-962-1368.

The Honor System
Every student enrolling through Off-Campus Credit Studies is responsible for good citizenship in student life. This responsibility includes:

the duty to respect and uphold the honor system; specifically, to refrain from cheating, stealing, lying, and to report any violations;
the duty to respect and uphold the campus code; namely, to conduct yourself so as not to impair significantly the welfare or the educational opportunity of others in the university community.

Your signature on this form indicates that you understand and accept the responsibility outlined above. Falsifying or withholding information in completing this form is a violation of the honor code. Before this form will be accepted and processed, you must indicate your agreement to abide by the honor system by signing below.

Your signature ______________________________________________________ Date____________________

Nondiscrimination Policy
The University of North Carolina at Chapel Hill is committed to the principle of equal opportunity. It is the policy of this University not to discriminate on the basis of race, sex, color, national origin, religion, or disability with regard to its students, employees, or applicants for admission or employment. Such discrimination is also prohibited by federal law. Any complaints alleging failure of this institution to follow this policy should be brought to the attention of the University Counsel, Leslie C. Strohm, 919-962-1219.

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