International English Center
Division of Continuing Education and Professional Studies
University of Colorado at Boulder

Online Course Form

To register for an International English Center (IEC) online course, complete and print this form. You may then mail or fax the form (address and fax number at the bottom). You must include payment with this form.

Once your registration form and payment have been received and processed, you will receive an email with instructions on how to access the course.

Please note that you may drop with a refund or transfer to another IEC online course within 40 calendar days after registration. No refunds are possible after that period.

Full legal name
Last First Middle
Former or Maiden

Current or Former CU student number

Mailing Address Line 1

Mailing Address Line 2

City, State Zip+4

Home Phone Work Phone
E-mail address*
*Required for online courses.

Birthdate (month/day/year – mm/dd/yyy) / / Age

Gender
Male
Female

Home State or Country

Citizenship
C=U.S. Citizen
P=Non-U.S. Citizen/permanent status - Alien registration no.
T=Non-U.S. Citizen - Country - Type of Temporary Visa (if applicable)

Please note: The Form I-20 (Eligibility for Student Visa) cannot be issued by the University of Colorado for online study.

Do you have a bachelor’s degree? No Yes College or University Name/City/State
Date awarded

1. Have you ever enrolled for credit course(s) at any campus of the University of Colorado (CU)? No
   Yes Campus Term Year of most recent attendance
2. Are you currently on suspension from any CU campus/school? No Yes
   School
3. Do you owe a debt to any University of Colorado campus? No Yes
4. Have you ever been convicted of a felony? (other than traffic violation) No Yes (Attach statement)
5. Name of Graduate or Professional Degree Program and University to Which You Belong or Are Applying
   
6. Number of Terms You Have Attended This Program
7. Name and E-Mail Address of Your Program Advisor
8. Your Native Language

   Reason for Applying for the Module

   Please give a brief assessment of your English language skills, identifying what you believe are your strengths and weaknesses.

   Check the module for which you are applying. We recommend that you take the modules in sequence. The tuition is $77.00 for Modules 1 and 2 and $154.00 for Modules 3 and 4.

	Section No.	Title of course	Tuition
	NCIE 7100-143	Module 1 - Graduate Writing: Description, Summary and Abstract
	NCIE 7100-144	Module 2 - Graduate Writing: Persuasion, Analysis and Argument
	NCIE 7100-145	Module 3 - Graduate Writing: Prospectus and Proposal
	NCIE 7100-146	Module 4 - Graduate Writing: Research and Citations
		Total Enclosed $
	NCEM 0099-581	Module 1 - Academic Writing: Description and Summary
	NCEM 0099-582	Module 2 - Technical Writing: Processes and Graphics
	NCEM 0099-583	Module 3 - Defining Problems, Analysis and Argument, Memos and E-mail
	NCEM 0099-584	Module 4 - Proposals, Abstracts, Executive Summaries, and Citations
Total Enclosed $

I hereby certify that to the best of my knowledge the information furnished on this application is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejection or dismissal. Admission to the University of Colorado as a nondegree student does not guarantee eligibility for regular degree status.

I agree to observe all campus policies and regulations including the University honor code.

Student's Signature

Date

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Check enclosed made payable to the University of Colorado

Charge: VISA MasterCard Discover

/	/	/
Expiration Date	/

Cardholder's name

Print the form and fax it to 303-492-5515, or mail the form to:

International English Center
Division of Continuing Education and Professional Studies
University of Colorado at Boulder
63 UCB
Boulder, CO 80309-0063

10/2008

Return to the Registration page