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.
Format: (000) 000-0000.
UIW Email Address
*
Confirmation Email
Select the applicable semester
*
Fall I
Fall II
Spring I
Spring II
Summer
Specify Term, Course(s, and CRN to be added:
*
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 reflect additional tuition that will need to be incorporated in your financial aid award package? **This will not automatically increase your loans to cover the additional tuition cost**
Yes
No
Would you like to request your federal loans be increased to account for the additional MPH tuition, and additional living expenses? If you select yes, please expect an email from Ms. De La Rosa with additional documentation to be signed.
Yes
No
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
Should be Empty: