Graduate Studies Registration Form

Today’s Date:
Choose Program: / MBA / PSY / RCP Worc. / RCP OL / SCP / SED / HAP / CAGS
Choose semester: / Fall / Spring / Summer / Summer I / Summer II / Year:
I am registering: / Part-time (less than 9 credits) / Full time (9 credits or more)
Complete the following information: / Check here if this is new information:
Student ID:
Last, First, MI: / Cell Phone:
Mailing Address: / Home Phone:
City, State, Zip: / Work Phone:
Personal Email: / AC Email: / @assumption.edu
Emergency Contact (EC): / EC Phone:
Are you registering as a special student (non-matriculated)? / Yes / No
Have you attended Assumption College before: / Yes / No /
If yes, most recent semester and year attended:
I completed my undergraduate degree at Assumption College: / Yes / No /
If yes, list graduation year:
COURSE# / SEC / COURSE TITLE / CR / DAY / TIME / B/Rm. / TUITION
To remit payment online via Payment Gateway using your checking, statement savings, or credit/debit card, go to: https://assumption.afford.com/. Please note that a small convenience fee will be applied to credit/debit card payments. / Registration Fee / $20.00
Technology Fee: / $50.00
Less Tuition Deposit:
Total Tuition Fees: / $
RECORD OF PAYMENT / City of Worcester/MBA
Diocese
Cash: / $ / HECCMA (formerly the Worcester Consortium)
Nativity School
Check: / $ / Promissory Note-Employer
Date of Check: / Scholarship
Check #: / Stafford Loan-Verified: / $
Payment Gateway confirmation #: / Traineeship (Fellowship)
Tuition Payment Plan
Credit Card: / $ / Tuition Remission-Assumption College
Payment Gateway confirmation #: / UMass Medical School (UMMS)
Voucher
Program Director Approval: / Other:
Date of Approval:
Original: / Registrar / Photocopies: / Department / Student Finance / Rev: 03/19/15