Warner Non-Matriculated Student Application

Student Administration Support System (SASS)
REGISTRATION DEADLINE: Three (3) days before class start date.

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
Previous Name (if you attended under a different name at some time)
Middle Name (or Initial)
Preferred Name (Nickname, if chosen)
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
Social Security Number (if you've never taken Warner classes before)--numbers only--ENCRYPTED
--OR-- URID (ONLY if you've taken classes at Warner before)
Must be 8 digits. Currently Entered: 0 digits.
Date of Birth Date of Birth / MM / DD YYYY
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
Have you attended the University of Rochester before?

Have you attended the University of Rochester before? Yes No
If YES, approximate last year of attendance at the UR:
Highest degree you have completed (must have completed at least a Bachelor's degree):

Highest degree you have completed (must have completed at least a Bachelor's degree): Bachelor's Master's Doctoral Medical or Dental
What was your area of study?
Have you registered for any class(es) as a non-matriculated student (not yet admitted to a program) at Warner?

Have you registered for any class(es) as a non-matriculated student (not yet admitted to a program) at Warner? Yes No
If YES, how many courses have you completed?

If YES, how many courses have you completed? 1 2 3 Other Other

NOTE: You are allowed to transfer in no more than 3 retroactive credits into one of Warner's programs if you are planning to apply; students may petition Admissions to take one more class, IF they have an application in process, but it must be done prior to registration.
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
Have you already submitted an application to Warner?

Have you already submitted an application to Warner? Yes No
If you HAVE APPLIED to Warner, when do you plan to start (PLEASE SELECT TERM & YEAR)?

If you HAVE APPLIED to Warner, when do you plan to start (PLEASE SELECT TERM & YEAR)? Fall 2023 Spring 2024 Summer 2025
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) - ### - ### ####
Phone Type:

Phone Type: Cell phone Land line phone
Home Phone Number, if different from Preferred Phone Number Home Phone Number, if different from Preferred Phone Number - ### - ### ####
Phone Type:

Phone Type: Cell phone Land line phone
Work Phone Number Work Phone Number - ### - ### ####
Phone Type:

Phone Type: Cell phone Land line phone Pager
International Phone Number(s)--Please include preferred number, home, and work numbers:
Primary International Phone Type:

Primary International Phone Type: Cell phone Land line phone
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 Country of Residence:
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 Phone Type:

Emergency Contact's Phone Type: Cell phone Land line phone
Emergency Contact's e-mail:
FINANCIAL STATEMENT

See https://www.warner.rochester.edu/files/studentservices/forms/tuition_fees.pdf for the Tuition, Fee & Refund Schedule
Anticipated Enrollment

Anticipated Enrollment Full-Time (9 or more credits) Half-Time (6 - 8 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 https://www.warner.rochester.edu/students/registration/take-a-course for a list of courses
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

Reminder: up to a total of three (3) classes will be accepted as retroactive credit in one of Warner's programs.
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

Reminder: up to a total of three (3) classes will be accepted as retroactive credit in one of Warner's programs.
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

Reminder: up to a total of three (3) classes will be accepted as retroactive credit in one of Warner's programs.
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

Warner Non-Matriculated Student Application

Warner Non-Matriculated Student Application

PERSONAL INFORMATION

EDUCATIONAL HISTORY

CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

FINANCIAL STATEMENT

COURSE REGISTRATION See https://www.warner.rochester.edu/students/registration/take-a-course for a list of courses

COURSE REGISTRATION
See https://www.warner.rochester.edu/students/registration/take-a-course for a list of courses