For filing purposes, enter first
letter 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)
Baptist
Buddhist
Church of Christ
Congregational
Local Address
(check if this is a new address) City
State
Zip+4
Disciples of Christ
(
)
This registration is for:
Division:
Last Semester Episcopalian/Anglican
Hindu
Local Phone
Year:
Attended:
Islam
(
)
Undergraduate
Fall
Jewish
Business Phone
Select
Lutheran
/
Graduate
Spring
One:
Date of Birth
Methodist
year/term
No religion
Summer
CAPS
Other Christian
Other non-Christian
Citizenship/Country
Gender
Ethnicity
Race (Mark one or more)
Other Protestant
USA
A
Hispanic or 1-American Indian or Alaska Native
Orthodox Catholic
2-Asian
Male
Permanent Resident (country)
P
Latino
Presbyterian
3-Black
or
African
American
Non-Resident (country)
F
Not Hispanic 4-Native Hawaiian or Other Pacifis Islander Roman Catholic
Female
Unitarian
Refugee (country)
R
Student I.D. Number
Last Name (PRINT CLEARLY)
First
or Latino
Required:
CRN
Subject
Area
Course
Section
Number Number
5-White
Enter "AU"
to Audit
Middle
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 of
TOTAL
HOURS
withdraw in 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.10/9/09