Registration Form

Summer Term Registration

For Non-Degree Students

We're glad you're considering spending part of your summer with us. Before you can register for a class on BlueNet, the Office of Registration and Records needs to receive this information form for non-degree students so it can issue and email to you a login name and password via email.

You can submit the form electronically, or you may download the non-degree student registration form and fax it to the Office of Registration and Records at (630) 617-3245. You also can mail the form to the Office of Registration and Records, Elmhurst College, 190 Prospect Ave., Goebel Hall, Elmhurst, Il. 60126.

Please note: Upon submission of this form you are registering for the course(s) indicated and will be responsible for payment upon receipt of billing.

1.Contact Information
First Name*
2.
Last Name*
3.
Address*
4.
City*
5.
State*
6.
Zip Code*
7.
Country*
8.
Email Address*
9.
Phone Number*
10.Additional Student Information
Date of Birth (mm/dd/yyyy)
11.
Social Security Number
12.Gender
Male
Female
13.Are you a self-supporting individual who has lived in Illinois as other than a college student for at least 12 months immediately prior to enrollment in an Illinois college?
Yes
No
14.Have you ever attended Elmhurst College?
Yes
No
15.Are you currently attending another institution?
Yes
No
16.
If yes, name of institution
17.Ethnicity
American Indian/Alaskan Native
Asian/Pacific Islander
Black/African-American
Caucasian
Hispanic/Puerto Rican
Other, specify
18.Course Registration
Please include Dept. No. Section and Title.
For example: CHM 103-30 Elementary Organic and Biochemistry
*

Elmhurst College • 190 Prospect Avenue • Elmhurst, Illinois 60126-3296 • (630) 279-4100 or (630) 617-3500

 

Undergraduate Admission • (630) 617-3400 • (800) 697-1871 • admit@elmhurst.edu

School for Professional Studies • (630) 617-3300 • (800) 581-4723 • sps@elmhurst.edu

Elmhurst Learning and Success Academy Admission • (630) 617-3752 • elsa@elmhurst.edu

 

Technical Support

loading