All non-degree applications will be processed based on course availability.  All degree seeking students have first priority.

Term registering for:  Choose one:                    Field Summer Fall    Choose one:  2008

Last Name:                                  
First Name, Middle Initial:            
Social Security Number (NO dashes or spaces) or CSM-CWID:               

    If you are a returning student, complete the following section only if you
    have changes to report from the previous semester, except for residency, which
    must be completed.  New Students are required to complete the entire form.

    I.  Personal Information

     Mailing Address: 

     Mailing Address: 

     City:                    County:       

     State:                   Zip Code:               

     E-Mail Address:   

     Work Phone:        Home Phone: 

     Sex:      Male     Female

    Ethnic Background:                Caucasian, non-Hispanic (white) American Indian/Alaskan Native Asian or Pacific Islander Black, Non-Hispanic Hispanic International

    Marital Status:        Single    Married      Separated
                                  Divorced    Widowed    Other

    Age:                    Birthdate:                (Format  mm/dd/yyyy)

    Birth City:            

    Birth State or Province:                 

    Country of Birth:                        

    Citizenship:    U.S.    Non-resident alien    
                         Permanent resident alien (green card)

  United States Visa Information:

        Type of Visa:   
        PR Number:    
        Country:          

    Previous Degrees earned:   (List degree and institution earned.)
       
       
       

    High School (if current High School Student)
       

If current High School student answer the following questions:
I have contacted the CSM Math department. (If taking a Calculus Course)
I have not contacted the CSM Math department. ( If taking a Calculus Course)    
I have contacted the CSM Admissions Office
I have not contacted the CSM Admissions Office.

If Senior Citizen (62 yrs or older) answer the following question:
I would like to take this course for No-Credit (up to 3 hrs in one semester).

    Signature:  (Fill in name)   
    Date:       (Format  mm/dd/yy)

    Your printed name in this box will indicate your signature to the above information

II.  Course Registration
    Please enter each course by course number including section number and 
    semester hours.  Include laboratory if applicable. Example:  CHGN121A,
   CHGN121LA.

Total Hours Requested for Registration:             

III.  Student Fees

    Student fees are optional to non-degree students taking 1-3 credits, except
    for the Technology fee of $60.00 which is mandatory for all students ($30 
    during Field and Summer Sessions).  If you are registering for 1-3 credits, you
    may skip this section.
    
    Students taking 4 or more credits may apply for a waiver of the student fees
    (see below).  All students taking 4 or more credits are required to pay all
    student fees.  Payment of student fees allows a student to participate in athletics,
    use of the health center (it does not provide health insurance) and the Student
    Center activities.

    If you are planning to register for 4 or more credit hours, you may request a
    waiver of the student fees (except for the Technology Fee).  If you do not 
    request a waiver of the student fees below, you must include payment for all
    the student fees.

    Student Fee Waiver Request:
    I am registering for 4 or more credits and wish to apply for a waiver of the
    student fees, except the Technology Fee:   Yes   No

    The following are possible reasons for granting a fee waiver (check all that
    apply to you):

    I am enrolling for 4 or more credit hours.
    I work off campus full time.
        Name of Company:        
        Name of Supervisor:        
        Phone Number:              
    I am on campus only for my classes.
    I am not making use of any campus facilities other than for my classes.
    I am currently a high school student. 
        Name of High School             
        Phone Number for School      

    IV.  Financial Information: An invoice will be sent to you showing tuition for course(s) and fees.
                                                 Please make payment payable to CSM.
       

.    V.  Residency Form Complete this section if you are claiming in-state tuition
      classification and have not previously completed this form or if you need to
      update your information previously submitted. (Enter dates as month/year, e.g., 4/80 or 11/75.)

I have previously attended Colorado School of Mines as a matriculating or non-degree student and have submitted the appropriate information regarding my Colorado residency status. (If the appropriate information has previously been submitted, check this box, and skip to section VI).

NOTE: If you are a Colorado resident and this information is or was not submitted, you will be charged non-residency tuition.

VI.  Selective Service Form - Information on Selective Service registration status
  must be provided in order to comply with Colorado law.  Individual's providing
 false information are subject to penalty of law.

    I certify that I am registered with the Selective Service.
    I certify that I am not required to register with the Selective Service because:
          (check all that apply to you.)
    I have not reached my 18th birthday.
    I was born before 1960.
    I am 26 years of age or older.
    I am female.
    I am a foreign national in the United States on a student visa. 
    I am in the armed services on active duty.  (Note:  does not apply to
        members of the Reserves or National Guard who are not on active duty.  
    I am a permanent resident of the Trust Territory of the Pacific Islands or 
        the Northern Mariana Islands. 

    Other: (please specify):   

I hereby certify that, to the best of my knowledge, the information furnished here is
true and complete without intent of evasion or misrepresentation.  I understand that 
if it is found to be otherwise, it is sufficient cause for rejection or dismissal.

Your printed name in this box will indicate your signature to the above information.

Name:              
Date of Submission:              (Format mm/dd/yyyy)

All notifications will be sent to the email address you provided above.

PLEASE SUBMIT ONLY ONCE - THANK YOU.