FAMILY/LAST NAME: GIVEN/FIRST NAME: MI: Permanent Address: Phone: City: State: Zip Code: Email Address: @my.bridgeport.edu DEGREE SOUGHT: ( ) A.A. ( ) B.S. Major/Academic Program: # # SECTION # COURSE NAME DAY START TIME *LOCATION INSTRUCTOR TUITION & FEES COURSE OF (Office use only) DATE ($525.00 per credit CREDITS $1,575.00 per course) $ $ $ $ Total # Credits Non-refundable General Fee: $ 215.00 TOTAL $ Type of Payment: Financial Aid Self Pay Tuition Reimbursement Corp 10% Company: and agree to comply with and be governed by the University of Bridgeport (the “I accept full academic and financial responsibility for the courses in which I have enrolled and procedures as set forth in the Catalog, Key to UB-University of Bridgeport Student Handbook, University website or other publication, as “University”) policies amended from time to time. Furthermore, I have read, understand, and accept the terms and conditions of the Student Enrollment and Financial Responsibility Agreement, available at http://bridgeport.edu/docs/FinancialAid/Student_Enrollment_and_Financial_Responsibility_Agreement.pdf, and understand that those terms are incorporated herein by reference.” I have read and understood all the conditions listed above. PLEASE CHECK: Student Signature: Date: Advisor Signature: Date: FAX : Bridgeport office (203) 576-4537 * LOCATION : Bridgeport (ID), Stamford (RB), Waterbury (WB), Online
FAMILY/LAST NAME: GIVEN/FIRST NAME: MI: Permanent Address: Phone: City: State: Zip Code: Email Address: @my.bridgeport.edu DEGREE SOUGHT: ( ) A.A. ( ) B.S. Major/Academic Program: COURSE # SECTION # (Office use only) # OF CREDITS COURSE NAME DAY START DATE TIME *LOCATION INSTRUCTOR TUITION & FEES ($525.00 per credit $1,575.00 per course) $ $ $ $ Total # Credits Non-refundable General Fee: $ 215.00 TOTAL $ Type of Payment: Financial Aid Self Pay Tuition Reimbursement Corp 10% Company: “I accept full academic and financial responsibility for the courses in which I have enrolled and agree to comply with and be governed by the University of Bridgeport (the “University”) policies and procedures as set forth in the Catalog, Key to UB-University of Bridgeport Student Handbook, University website or other publication, as amended from time to time. Furthermore, I have read, understand, and accept the terms and conditions of the Student Enrollment and Financial Responsibility Agreement, available at http://bridgeport.edu/docs/FinancialAid/Student_Enrollment_and_Financial_Responsibility_Agreement.pdf, and understand that those terms are incorporated herein by reference.” PLEASE CHECK: I have read and understood all the conditions listed above. Student Signature: Date: Advisor Signature: Date: FAX : Bridgeport office (203) 576-4537 * LOCATION : Bridgeport (ID), Stamford (RB), Waterbury (WB), Online
FALL_2017_SPS_Registration_Form_a.docx