Warner Non-Matriculated Student Application

Student Administration Support System (SASS)

Today's Date Today's Date / MM / DD YYYY
Term you're registering for (select ONE): *

Term you're registering for (select ONE): Summer Fall Spring
Year *
PERSONAL INFORMATION
Last Name *
First Name *
Middle Name (or Initial)
Preferred Name (Nickname, if chosen) *
Previous Name (if you attended under a different name at some time)
Social Security Number (if you've never taken classes at the UR)--numbers only--ENCRYPTED
--OR-- URID (if you've taken classes at the UR before)
Must be 8 digits. Currently Entered: 0 digits.
Date of Birth Date of Birth * / MM / DD YYYY
Gender Choice (select ONE) *

Gender Choice (select ONE) Male Female Undisclosed
Are you Hispanic or Latino?

Are you Hispanic or Latino? Yes No
Race(s) (Check all that apply:

Race(s) (Check all that apply: American Indian or Alaska Native Asian, Indian (subcontinent), or Filipino Black or African American Native Hawaiian or Pacific Islander White or Caucasian
Citizenship Status (select ONE) *

Citizenship Status (select ONE) US Citizen Permanent Resident (with Green Card) International Student
Country of Citizenship *
If you have dual citizenship, in which country is your other citizenship?
Primary Language
Other Language(s) spoken
EDUCATIONAL HISTORY
Highest degree you have completed: *

Highest degree you have completed: Associate's Bachelor's Master's Doctoral Medical or Dental
What was your area of study?
Have you attended the University of Rochester before? *

Have you attended the University of Rochester before? Yes No
Approximate last year of attendance at the UR:
Do you plan to apply? If so, where?

Do you plan to apply? If so, where? Yes Warner No Other UR Graduate School School outside the UR complex Other Other
CONTACT INFORMATION
Mailing Address (include PO Box, if used) Mailing Address (include PO Box, if used) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
New York County (REQUIRED for NY Residents)
Residence Address during term (if same as Mailing Address, type SAME in each field) Residence Address during term (if same as Mailing Address, type SAME in each field) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Billing Address, if different from Mailing Address Billing Address, if different from Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Preferred Phone Number (where you can be reached during class) Preferred Phone Number (where you can be reached during class) - ### - ### ####
Home Phone Number, if different from Preferred Phone Number Home Phone Number, if different from Preferred Phone Number - ### - ### ####
Work Phone Number Work Phone Number - ### - ### ####
International Phone Number(s)--Please include preferred number, home, and work numbers:
Preferred Email *
Alternate Email
EMERGENCY CONTACT INFORMATION
Name of person we should contact if you are taken ill during class: *
Your Emergency Contact's relationship to you: *
Emergency Contact's phone number (REQUIRED unless you are entering international number): Emergency Contact's phone number (REQUIRED unless you are entering international number): - ### - ### ####
Emergency Contact's International Phone Number:
Emergency Contact's e-mail:
FINANCIAL STATEMENT

See Warner's website below for current tuition fee
Warner Tuition, Fee & Refund Schedule
Anticipated Enrollment *

Anticipated Enrollment Full-Time (12 or more credits) Half-Time (6 - 11 credits) Part-Time (1 - 5 credits)
Who will pay your tuition? (Check ALL that apply.) *

Who will pay your tuition? (Check ALL that apply.) Self pay (students can pay with an eCheck through UR Student when billed) Bank student loan (non-matriculated students do not qualify for Federal student loans) Employer UR Employee Tuition Benefit Waiver Other Other
Are you expecting to receive a Warner Tuition Award? (If YES, complete the Award Title below.) *

Are you expecting to receive a Warner Tuition Award? (If YES, complete the Award Title below.) Yes No If YES, percentage expected: If YES, percentage expected:
Warner Tuition Award Title (e.g., Dean's Award, DLS, East High, etc.):
Who can verify the terms of this Warner award? (i.e., Who promised you the award?)
PAYMENT AGREEMENT:

By typing my full legal name in the field below, I acknowledge my understanding that:
*I am financially responsible for any tuition and fees not covered by tuition awards or loans;
*I may forfeit my tuition award or benefit, if I fail to satisfactorily complete a class;
*Should I fail to pay any outstanding balance promptly, the University has the right to assess late fees and/or collection costs and to place holds on my account preventing future registrations or printing transcripts. *
COURSE REGISTRATION
See Course Schedule for details: https://www.warner.rochester.edu/programs/schedules
Class #1 Section Number (SEE COURSE SCHEDULE) *
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Course Number Prefix *

Course Number Prefix ED EDE EDF EDU
Course Number (404, 506, 545L, etc.) *
Number of credit hours *
Are you auditing (observing only) or taking this class for credit? *

Are you auditing (observing only) or taking this class for credit? Audit Credit
Course Title *
Course Instructor *
Class #2 Section Number
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Class #2 Course Number Prefix

Class #2 Course Number Prefix ED EDE EDF EDU
Class #2 Course Number (404, 506, 545L, etc.)
Class #2 Number of credit hours
Class #2: Are you auditing (observing only) or taking this class for credit?

Class #2: Are you auditing (observing only) or taking this class for credit? Audit Credit
Class #2 Course Title
Class #2 Course Instructor
Class #3 Section Number
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Class #3 Course Number Prefix

Class #3 Course Number Prefix ED EDE EDF EDU
Class #3 Course Number (404, 506, 545L, etc.)
Class #3 Number of credit hours
Class #3: Are you auditing (observing only) or taking this class for credit?

Class #3: Are you auditing (observing only) or taking this class for credit? Audit Credit
Class #3 Course Title
Class #3 Course Instructor
Class #4 Section Number
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Class #4 Course Number Prefix

Class #4 Course Number Prefix ED EDE EDF EDU
Class #4 Course Number (404, 506, 545L, etc.)
Class #4 Number of credit hours
Class #4: Are you auditing (observing only) or taking this class for credit?

Class #4: Are you auditing (observing only) or taking this class for credit? Audit Credit
Class #4 Course Title
Class #4 Course Instructor
Class #5 Section Number
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Class #5 Course Number Prefix

Class #5 Course Number Prefix ED EDE EDF EDU
Class #5 Course Number (404, 506, 545L, etc.)
Class #5 Number of credit hours
Class #5: Are you auditing (observing only) or taking this class for credit?

Class #5: Are you auditing (observing only) or taking this class for credit? Audit Credit
Class #5 Course Title
Class #5 Course Instructor
Class #6 Section Number
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Class #6 Course Number Prefix

Class #6 Course Number Prefix ED EDE EDF EDU
Class #6 Course Number (404, 506, 545L, etc.)
Class #6 Number of credit hours
Class #6: Are you auditing (observing only) or taking this class for credit?

Class #6: Are you auditing (observing only) or taking this class for credit? Audit Credit
Class #6 Course Title
Class #6 Course Instructor

Warner Non-Matriculated Student Application

Warner Non-Matriculated Student Application

PERSONAL INFORMATION

EDUCATIONAL HISTORY

CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

FINANCIAL STATEMENT

COURSE REGISTRATION See Course Schedule for details: https://www.warner.rochester.edu/programs/schedules

COURSE REGISTRATION
See Course Schedule for details: https://www.warner.rochester.edu/programs/schedules