Student Registration Services, SSC 2221
Phone (630) 942-2377
Fax: (630) 942-2878
Email: Registration_forms@cod.edu
(After mid-term)
Rcvd by:_________
Date:____________
___________________ ____________________
Term Date
_________________________
Student’s Name: Last, First, Middle Initial (Please PRINT clearly) C.O.D. Student ID Number
________________________________________________________________________________________
Street Address Apt. Number
______________________ ________________________________________ ___________ __________
Phone Number City State ZIP Code
_____________________________________ _______________________________________________
Course Name and Number Instructor’s Name
_____________________________________ _______________________________________________
Course Name and Number Instructor’s Name
_____________________________________ _______________________________________________
Course Name and Number Instructor’s Name
_____________________________________ _______________________________________________
Course Name and Number Instructor’s Name
To the Student: Please explain your request for late registration below.
NOTE: Requests for late registration will not be considered without a valid permit to register.
Student’s Signature Date
Copies: White – Registration; Yellow – Student
For Registration Office Use Only Decision:

•
A request for a late registration appeal will not be considered without a valid instructor’s permit to register.
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If you were dropped for non-payment from more than one class after mid-term, you must re-register for all classes from which you were dropped.
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Permits from instructors for all classes must be attached to this form at the time of re-registration.
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A $10.00 late fee will be charged for each class registered late.
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Payment in full must be made the same day you register.
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If full payment cannot be made, arrangements must be made with the Cashier’s Office before late registration will be granted.
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If a student is dropped a second time for non-payment, he/she may not be allowed to re-register.
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Late registrations must be submitted at least one day prior to the last regular class meeting.
Students will not be eligible to appeal for late registration during the week of Final Exams.
•
A decision will be made within three business days after submitting an appeal with instructor permit(s) attached.
RETURN COMPLETED FORM WITH ATTACHED PERMITS IN PERSON TO THE STUDENT REGISTRATION
SERVICES OFFICE, (SSC) 2221.
College of DuPage
Student Registration Services, SSC 2221
425 Fawell Boulevard
Glen Ellyn, IL 60137
(630) 942-2377
FAX (630) 942-2878
U:Home/Shared/Registration/Forms Revised 3/21/16