Worsham College Re-enrollment Form

Worsham College Student Re-Enrollment Form
Student Information
Name

First NameLast Name
Prior Name while a Student at Worsham (If Applicable)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email Address
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Authorization and Agreement
- I have read the policies in the Student Handbook, including the Academic Integrity Policy.
- It is my responsibility to complete and submit all assignments on time and my grade(s) is based on an assessment of my understanding of the concepts in this program.
- I am responsible for any tuition and fees that may result from my re-enrollment in the program. Tuition and fees may not be covered by financial aid for returning students.
- I will be enrolled in the next available semester based on course offerings and pertaining to my progress in the program.
- I must demonstrate satisfactory academic progress in accordance with the Satisfactory Academic Progress Policy.
- I acknowledge that my program requirements will be based on the most current college policies.

Worsham College . Re-enrollment Administrative Fee

Worsham College

Re-enrollment Administrative Fee

$250.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

This $250.00 re-enrollment administrative fee is fully refundable if Worsham College is unable to accommodate your request.

If you, the student, decide not to enroll before the start of classes, this administrative fee will be fully refunded back.
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