2016 UCI SUMMER SESSION
ENROLLMENT FORM
The best way to enroll is online! summer.uci.edu
Complete form in ink
1 . STUDENT INFORMATION
UCI ID #:
OTHER UC ID #:
FULL LEGAL NAME
LAST:
FIRST:
MIDDLE:
CITY:
STATE:
ZIP:
PRIMARY PHONE:
ALTERNATE PHONE 1:
ALTERNATE PHONE 2:
oCELL oHOME oWORK
oCELL oHOME oWORK
oCELL oHOME oWORK
BIRTH DATE
(MM/DD/YYYY):
SEX: oMALE oFEMALE
STREET ADDRESS:
EMAIL (REQUIRED):
SOC SEC#:
-
-
2. STUDENT STATUS
WHERE DID YOU ATTEND IN SPRING 2016?
o UCI o UCB o UCD o UCLA o UCR o UCSB o UCSC o UCSD o UCSF o UCM
o Other College: ___________________________ o High School (Enclose Transcript) o Other/Visitor
WILL YOU BE AN INCOMING UC STUDENT NEWLY ADMITTED FOR FALL 2016?
o NO
o YES, CAMPUS: _______________________________
o Freshman o Sophomore o Junior o Senior o Graduate Student o College Graduate / Non-Student
WHAT WILL BE YOUR CLASS LEVEL IN FALL 2016?
o Graduating after Summer Session o High School Graduate/Non-Student o Continuing High School Student
WILL YOU RECEIVE A BA/BS THIS SUMMER? o YES o NO
WILL YOU BE RECEIVING FINANCIAL AID FROM YOUR HOME UC CAMPUS THIS SUMMER? o YES* o NO
Please Note: International Student Application forms for visiting non-UC international students are available at summer.uci.edu/international
3. COURSE SELECTION
STATUS
UC Undergraduate
UC Graduate
Other/Visitor
PER UNIT COST**
$271
$339
$339
8-UNIT FLAT FEE**
$2168
$2712
N/A
COURSE DEPT & NUMBER
(ex: Anthro 2A)
SESSION I, II or 10wk
5 DIGIT COURSE CODE
Course Fees: Multiply appropriate per unit fee by the total number of units for
each course. If you are a UC student enrolling in more than 8 units, use the 8-unit
Flat Fee (some exceptions apply, see summer.uci.edu for details). Course Fees
become non-refundable after the refund deadline has passed.
UNITS
LETTER GRADE, P/NP, AUDIT
Graduate Students S/US
COURSE FEE**
(Per Unit)
MATERIALS FEES
(non-refundable)
4. PAYMENT
**TOTAL OF ABOVE FEES (COURSE AND MATERIALS FEES) …………………………………………………………………………….
**ADD THE MANDATORY CAMPUS FEE (Non-refundable)…………………………………………UCI or UC $165 / VISITORS $265
LATE FEE (If applicable) Deadlines can be found on the calendar at summer.uci.edu …...……………………………………
YOUR TOTAL FEES DUE ARE ………………………………………………………………………………………………………………….
PAYMENT METHOD
CREDIT CARD:
o VISA
o MC
$ ________________
$ ________________
$ ________________
$ ________________
o Check/money order payable to the “UC Regents” in the amount of US$: ___________________
o AMEX
AMOUNT TO CHARGE (US$): __________________
CARD #: _________________________________________________
NAME ON CARD:__________________________________________
EXPIRATION: ___________
TODAY’S
DATE: _________________
BILLING ADDRESS: ______________________________________________________________________________________
CARDHOLDER’S
CARDHOLDER’S
PRIMARY PHONE #: __________________________
SIGNATURE: ______________________________________________
5. STUDENT SIGNATURE AND DATE
I have read and understand the policies listed in the Student Services section of the UCI Summer Session website regarding academic information, deadlines,
registration, fees and refunds.*** I understand the mandatory campus and materials fees are non-refundable, and course fees become non-refundable after the refund
deadline has passed. For more information, call (949) 824-5493. Refer to the calendar at summer.uci.edu for deadlines.
___________________________________________________________
SIGNATURE
____________________
DATE
Mail to:
UCI Summer Session
P.O. Box 6050
Irvine, CA 92616-6050
*Financial Aid Recipients: You may be responsible to pay ALL fees (i.e. course fees, mandatory campus fee, late fee, and materials fees) if you do not finalize your award or you decline any
or all of your award. It is your responsibility to meet all financial aid requirements and deadlines.
**Course fees for Summer Session are pending the State budget and approval by the Regents of the University of California. Your student status is subject to verification by the UCI Registrar.
As such, your fees may be adjusted at any time.
***A copy of the student policies is also available at the UCI Summer Session Office.
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IMPORTANT DATES 2016
SESSION I
10-week
SESSION II
JUNE 20 - JULY 27
JUNE 20 - AUGUST 26
AUGUST 1 - SEPTEMBER 7
Last day to enroll without a $50 late fee
JUNE 17
JUNE 17
JULY 29
First day of instruction
JUNE 20
JUNE 20
AUGUST 1
Last day to add, drop, or change grade option
without instructor’s signature
JUNE 24
JULY 1
AUGUST 5
Last day to enroll without a $100 late fee
JULY 1
JULY 1
AUGUST 12
Last day to apply for a refund of course fees/
No refunds after these dates
JULY 1
JULY 15
AUGUST 12
Holiday
JULY 4
JULY 4
SEPTEMBER 5
Absolute deadline for any course changes
JULY 8
JULY 29
AUGUST 19
JULY 26, JULY 27
AUGUST 26
SEPTEMBER 6, 7
AUGUST 4
SEPTEMBER 7
SEPTEMBER 15
Summer 2016 program dates
Final exams
Grades available
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