Granite State College Undergraduate and Post-Baccalaureate Registration Form Today’s Date:
Month
)
Date
Year
)
City/Town
State
)
Zip Code
Middle Name (required)
Work/Daytime Phone (
Other Names Used Within the University System
Cell Phone (
First Name
Male
2. Are you Hispanic/Latino? Yes
Course Dept
Course Number
Credit Course Title
Master’s
None None
Other
A FREE TEXTBOOK*
Register by Friday, June 7th at 9 am for a chance to win
35.00**
Course Charge
For 4 or more credits. ** Please note: Course charges, fees and regulations are subject to approval by the USNH Board of Trustees and change without prior notice.
*
*All students who register before 9 am on Friday, June 7th will automatically be entered into a drawing for a free textbook. Undergraduate registrations only.
Number of Credits
Registration Fee
Location
Native Hawaiian or other Pacific Islander What institution(s)
Course Reference Number
Doctorate
Other
American Indian or Alaska Native PSU
Bachelor’s
Asian KSC
No
Academic Services Fee* 40.00** How are you planning to pay? Totals Paying in full today or by the posted due date for the term (see payment options below) Financial aid—Check the status of your Financial Aid on WebROCK Other Third Party Source (VA, VocRehab, Employer, Scholarship) Documentation will be received by the due date for the term. National Guard (NG Waiver, Army Tuition Assistance, POST 9/11 GI Bill). Other (Alternative Loan, Private Loan, Tuition Management Systems Payment Plan, USNH Tuition Waiver) Payment Options: E-Pay through your secure WebROCK account • Call 1.888.228.3000, ext. 330 • Mail payment to Granite State College, Student Accounts Office, 25 Hall Street, Concord, NH 03301
Student’s Signature
Office Use
5. What degree(s) do you hold? Associate
UNH
Black or African American
4. Degree Candidate: GSC
White
3. Please indicate your race by selecting one or more of the following:
1. Are you: Female
The following information is used for statistical purposes only. Your responses are optional.
No I have received information on the USNH “Residency Rules.” Yes Link to information on residency rules: http://usnholpm.unh.edu/BOT/IV.Fin/F.htm No I verify that I have been a New Hampshire resident for at least twelve consecutive months for purposes other than my education. Yes No Are you a U.S. Citizen? Yes If you have a documented disability which requires special services, please notify us.
Mailing Address
Date of Birth (required)
Home Telephone (
Email Address
Full Legal Name (required) Last Name
(Your SSN is required by federal law and is held in strictest confidence.)
Campus/Advisor New Student Provide Your GSC Student ID If this is your first registration for credit-bearing courses at GSC, provide your Social Security Number.
Please complete this top section in its entirety. PLEASE PRINT LEGIBLY.
Notes: (for office use only)
INSTRUCTIONS: (1) COMPLETE all items. (2) FILL in and TOTAL all charges due. (3) SIGN this form at the bottom. (4) Call 228-3000, fax completed form to 603.513.1386 or mail to Office of the Registrar, 25 Hall Street, Concord, NH 03301
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