MPH Registration Request
This form is only applicable to MPH students who need to register for courses.
*Please consult your MPH Academic Advisor prior to completing this form.
Date form was submitted
*
/
Month
/
Day
Year
Date
Name
*
Last Name
First Name
UIW Identification Number
*
Phone Number
*
Please enter a valid phone number.
UIW Email Address
*
Confirmation Email
Select the applicable semester
*
Fall
Spring
Summer
Course(s) to be added:
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What funds will you be using to pay for the tuition/fees for the course?
*
If, I have the option, I would like to use federal loans to pay for the course(s)
I will be using private loans to pay for the course(s)
I will be paying for the course(s) using personal funds
Do you authorize UIWSOM to route a Cost of Attendance adjustment to the UIW Office of Financial Assistance to increase your federal loans, if needed, to pay the tuition
Type option 1
Type option 2
Type option 3
Type option 4
If available, would you like to request federal loans to help cover your living
Type option 1
Type option 2
Type option 3
Type option 4
By submitting this form, I confirm I have consulted my MPH Academic Advisor and authorize UIWSOM to register me in the course(s) requested above.
*
I agree
Submit
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