IWU Graduate Education - Elective Registration Form

CGS Elective Registration Form
Please print this form and send it to:
ATTENTION: AGS Accounting
1900 W 50th Street
Marion, Indiana 46953-5279

Fax to Accounting 1-765-677-2760

If you have never been registered as a student a CGS program, click here to complete an Unclassified Application.
Please make sure your SIGNATURE is submitted with this form

SECTION #1 COURSE INFORMATION Code # ___ ___ ___ ___ ___ ___ ___ Course:___________________________________ ONSITE__ ONLINE__ City:__________________________ Registration Deadline:_________________ Start Date:_____________________ End Date:___________________________ ____ On-Site 3 credit hour..Tuition $_____ _____ Online 3 credit hour........Tuition $_____ ____ Online 1 credit hour....Tuition $_____ _____ Self-Study 1 credit hour..Tuition $_____ Books $______________ If you are not a current CGS student, an "Unclassified Application" needs to be completed first. Email graduate@indwes.edu to request one.
SECTION #2 GENERAL INFORMATION Name:____________________________________________ Soc.Sec.#:________________________________________ Core Group #:_________________ Delivery Address:__________________________________ (Must provide a street address) City:____________ State:____ Zip:________ Daytime Phone:_________________________ E-mail Address:_________________________ How did you hear about this class? ___________________	SECTION #4 PAYMENT OPTIONS (You are not registered unless payment is received) __ 1. Visa/Mastercard/Discover# _______________________________________ Exp. Date:___________ Charge: [ ] books [ ] tuition [ ] charge books and tuition now __ 2. Check/Money Order Enclosed: $______________ __ 3. Employer Voucher Enclosed: $_______________ (an actual voucher must be enclosed, not a voucher application) __ 4. Financial Aid - I have verified that financial aid is available and all forms are complete.
SECTION #3 STATISTICAL DATA Required for Institutional Reporting Race:______________ Citizenship:______________ Birthdate:___________ Marital Status:___________ Religious Affiliation:__________________________ Undergraduate Degree:___________________________ Date of Graduation:_______________ Have you attended classes at Indiana Wesleyan University (Formerly Marion College)? YES NO Proof of Bachelors degree (attached)	OFFICE USE ONLY: ID#:_______________ Amt. Rec:$__________ Check #:________________________________ Tuition:______________ Book:_____________ Late Fee:______________ Ok'd:_____________ Date Proc:____________ Ac Approval________ Date Registered by Student Services:__________

Signature (required): ________________________________________