For filing purposes, enter first
three letters of last name in box.
www.xavier.edu/registrar
REGISTRATION FORM
Office of the Registrar, 3800 Victory Parkway, Cincinnati, OH 45207-3131 Phone 513 745-3941 FAX 513 745-2969
Religion
(circle one)
Student I.D. Number
Local Address
Last Name (PRINT CLEARLY)
(check if this is a new address) City
(
)
Local Phone
(
)
Business Phone
Date of Birth
Gender
Required:
Subject
CRN
Undergraduate
Spring (01)
Graduate
Summer (05)
CAPS
Citizenship/Country
Female
Area
Course
Section
Number Number
A
P
F
R
Ethnic/
Racial
Origin
(circle one)
/
year/term
1-Black, Non-Hispanic
2-Amer. Indian/Alaskan Native
3-Asian/Pacific Islander
4-Hispanic
5-Caucasian, Non-Hispanic
6-Other
Enter "AU"
to Audit
Zip+4
Last Semester
Attended:
Division:
Fall (09)
Select
One:
Middle
State
This registration is for:
Year:
USA
Permanent Resident (country)
Non-Resident (country)
Refugee (country)
Male
First
Baptist
Buddhist
Church of Christ
Congregational
Disciples of Christ
Episcopalian/Anglican
Hindu
Islam
Jewish
Lutheran
Methodist
No religion
Other Christian
Other non-Christian
Other Protestant
Orthodox Catholic
Presbyterian
Roman Catholic
Unitarian
BP
BU
CC
CG
DC
EP
HI
IS
JE
LT
MT
NR
OC
ON
OP
OR
PR
RC
UN
Credit
Class Title
Hours
Days
Time
1
2
3
4
5
6
7
8
9
10
11
NOTE: Failure to attend class is not sufficient notice to the University in
TOTAL
HOURS
order to qualify for a refund and may result in a punitive grade of "VF"
(failure to officially withdraw).
Required: Subject
CRN
Area
Course Section Enter "AU"
Number Number to Audit
Alternate Classes
Credit
Hours
Days
Time
1
2
3
4
Student's Signature
Date
Advisor's Signature (for undergraduate students only)
Date
Dean's Signature
Date
(if undergraduate taking more than 18 hrs. or graduate more than 15 hrs.)
White-Registrar, Pink-Student, Gold-Advisor
office
use
only
Rev. 2/10/05