in vat mod INS 010.1.

in vat mod INS 010.1. U niversityVi of t he rginislands www.uvi.edu ryl0ilIGAIIYAW/1O/4 thg,t/(1%. ChWIPIKOI 6.06111,1 Val UN: Int REGISTRATION FORM Student ID Number # OFall OSpring OSummer 20 Campus: OSTT OSTX Level: OUndergraduate EIGraduate Name: Former Local Mailing Address: /4S7I Phone: Home Work Sex: O Male VI Female Date of Birth: U.S. Citizen OYes ON° Permanent Resident Alien Registration # Non Resident Alien: Type of Visa OF OJ OH In compliance with federal reporting requirements, UVI must seek to identify the ethnic background of students enrolled. You are encouraged to supply this information. O Black/Non-Hispanic O American Indian/Alaskan O Asian/Pacific Islander O Hispanic a' White/Non-Hispanic O Other In what state/country is your permanent residence? Have you lived in the Virgin Islands for the past twelve (12) months? O Yes O No Last attended UVI I certify that the information given on this form is complete and correct. I acknowledge that deliberate omissions or falsifications may subject me to immediate dismissal from the University. Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, you have the right to withhold the disclosure of any directory information. If you would like that your name not be listed in a directory please indicate. O Yes O No Student amyl iatuiu Date EFTA01124429 SIPICaUlal Pri•TONIS UnivercsitYVirginisiands 0, the www.uvi.edu REGISTRATION FORM p4SILMICAILYAVIIICAJ. .0AIVCAJIMINv GLOW./ n MI 1. The registration form must be COMPLETED PRIOR to entering the registration area, as it will be used to key your course request(s). 2. Please make sure the COURSE REFERENCE NUMBER (CRN #) has been entered correctly. Schedules must have a CRN# to be entered. 3. Changes in biographical data (name, address, telephone number) must be reported to the Registrars Office. O Undergraduate O Graduate OFall OSpring OSummer Year: Namel Address: Date: Tel: ID # (m) (h) M.I. (w) Email: Emergency Contact: (m) CRN# Tel: SUBJ Last Name (h) First Name (w) CRSE# SEC CRED DAY TIME AUDIT(Y/N) SAMPLE SCHEDULE 12345 MAT 231 A 4 MTWF 1:00-1:50 N OFFICE USE CRN# SUBJ CRSE# SEC CRED DAY TIME AUDIT Total Credits: Alternate Course Selection(s) Advisors Signature Student's Signature Office Use: PIP-Prerequisite in progress, PNM-Prerequisite not met, CTC-Course time conflict, CLS-Closed class. CRN-Wrong CRN, VVTL-Waitlisted EFTA01124430