Office Use Only
Rec’d in Office ____________________
Registration Completed ______________
Center for Professional Development
REGISTRATION FORM
Please note that registration is not complete until a SIGNED registration form and summary of tuition fees have been
received by UMUC Center for Professional Development. Please print and either fax (240-684-2513), email
pro@umuc.edu or mail to address below with purchase order or payment information. Questions? Call 301-985-7343.
Are you or have you ever been a UMUC student?
If so, please check this box
Today’s Date:
Student’s Name:
HOME
Dr.
Mr.
Ms.
WORK: Street Address
City
State
Zip
Email Address:
Work
Cell Phone:
Home Phone:
Date of Birth:
How did you hear about our program?
Advertisement
Employer:
Internet
Referral
UMUC
Other:
Title:
Education: Please check the one that applies to you:
Registration Information:
Check
box
Course(s)
How many years:
H.S. Diploma
Some College [or AA]
Location
(Dorsey/Quantico)
CON X1000
CON X1200
CON X1216
Start Date
College Degree [s]
Tuition
October 22, 2013
November 12, 2013
December 10, 2013
Total
Payment Options
Cash
Corporate
Check #:
Agency
Individual
Credit Card: Type:
Number:
Name on Card:
Signature:
Expiration Date:
PLEASE DO NOT EMAIL CREDIT CARD INFORMATION!
Agency/Corporate Information
Contact/Counselor Name
Phone Number
Company Name or Agency Office
P.O Number (Attach Copy)
Address
City
State
Zip

Checks/Money Orders: Made payable to “UMUC Center for Professional Development” and mailed to: UMUC Strategic Initiatives,
3501 University Boulevard East, Attn: Largo Suite 2271, Adelphi, MD 20783-8005.

Company Purchase Order: Please send to the address above. (Please note the purchase order must accompany the registration forms).
UMUC Center for Professional Development Tuition Fee Summary
This document summarizes some of the policies applicable to UMUC Center for Professional Development
students. You must also acknowledge your receipt, understanding and acceptance of them by signing below.
1) Full tuition must be paid at time of registration.
2) All students registering for classes with UMUC Center for Professional Development accept personal
responsibility for all financial obligations.
3) All start dates are tentative and classes run based on adequate enrollment. Classes may be postponed,
rescheduled, extended or cancelled due to insufficient enrollment, or reasonable circumstances beyond
UMUC Center for Professional Development’s control.
4) Should a student register and pay for a class that is cancelled, the student will be entered as TBD (to be
determined) status. The student has 6 months from the registration date to select another class or request
a refund. If neither action is taken, the student forfeits any refund or selection of another course.
5) Withdrawals 8 or more days in advance of a class start will receive a 100% refund (minus a $50 processing
fee). Withdrawals within the week (7 days or less) prior to the class start will be entitled to a refund; 25% of
the tuition plus the $50 processing fee will be forfeited. Withdrawals as of or after the start of class are not
eligible for refund. Date of acknowledgement is the date of UMUC Center for Professional Development’s
receipt of student’s written request of withdrawal and refund.
6) A $30 returned check fee will be charged to the student for any bank-rejected checks.
7) 80% attendance is required to receive a Certificate of Completion; unless noted in course material.
The undersigned acknowledges receipt and review of both the tuition summary above. The undersigned further
acknowledges understanding and acceptance of the terms of these policies, and will abide by all UMUC Center
for Professional Development rules and regulations at all times.
Student
Date
Center for Professional Development
*Subject to change without notice.
September 3, 2013
Center for Professional Development
Discounts
UMUC Center for Professional Development would like to offer a discount to our students who take
advantage of our offerings. Enjoy multiple discounts (option 1, 2, or 3) up to $250.
1. UMUC Student and Alumni Discount
UMUC students and alumni are eligible for a 10% discount. Please provide a copy of your UMUC student
ID or an unofficial transcript or the name of the UMUC course you have completed.
2. Early Registration Discount
Students who register at least three weeks in advance of the start of a course will receive a 10%
discount, up to $250.00.
3. Multiple Course Discount
Students who register for multiple courses are eligible for the following discounts:
# Courses
Discount
2
10%
3
15%
4 or more
20%
4. Multiple Student Discount
Multiple students from the same organization are eligible for the following discounts:
# Students
Discount
2-4
10%
5-10
15%
11 or more
20%
*Subject to change without notice.
September 3, 2013