Graduate School of

Biomedical Sciences

FORM GSBS59: NON-DEGREE STUDENT INFORMATION

Last Name: / First Name: / Middle Name:
Dr / Mr / Mrs / Ms / Miss / Email Address:
SSN: / Gender: / Birth Date:
Permanent Address
Address:
City: / State: / Zip: / Country:
Local/Current Mailing Address
Address:
City: / State: / Zip:
Telephone:
Emergency Contact
Name:
Address:
City: / State: / Zip:
Telephone:
Residency / Are you a resident of the Commonwealth of Massachusetts?
Residency is based on your Permanent Address, not your Current AddressCompleted Residency Form must be included with this document / Yes / No
Tuition Waiver / Will you be applying for a UMMS Tuition Waiver?
If yes, you must provide a completed Tuition Waiver Form to the Bursar. / Yes / No
Please complete if you are a UMMS Employee
Department: / Room: / Phone:
Signature / Date

Non-Degree Student Information

Information:

Courses offered by the GSBS at UMMS may be taken by the following, depending upon their academic background and upon space available in a given course.

  • UMMS or UMMHC employees
  • Students from the Worcester Consortium
  • Students registered as full time students at another University of Massachusetts Campus

A non-degree student

  • is not considered to be registered for a degree
  • may register for no more than two courses per semester unless approved by GSBS Dean
  • may not take a course as an audited course unless approved by GSBS Dean
  • will be unable to take any further GSBS courses if a grade of ‘C’, ‘MP’ or ‘F’ is attained in any course

Instructions

  • Obtain Course Coordinator’s approval
  • Complete Non-Degree Student Information Form (GSBS59)
  • UMMS Employees: UMMS Tuition Waiver Form (see UMMS Human Resources Policy # 3007 – Tuition Programs)
  • UMMHC Employees: Tuition must be paid to the UMMS Bursar at Registration.
  • Worcester Consortium Students: Consortium Cross-Registration Forms are available in the UMMS Registrar’s Office
  • Other University of Massachusetts Students: Intercampus Course Exchange Registration Forms are available in the UMMS Registrar’s Office
  • Students from other Universities: must provide written authorization from their home institutionand from a GSBS-approved UMMS sponsor that enrollment in GSBS courses is permitted. If the student is not a US citizen or permanent resident, he/she must also provide written verification of their visa status fromthe UMMS Human Resources Immigration Services Office (ISO).
  • Complete Proof of Residency Form (GSBS60; requires notarization)
  • Complete Non-Degree Student Registration Form (GSBS58)
  • Take, in person, completed documents and means of verification of identification (see form GSBS60 for details) to the Registrar’s Office for verification of identification and registration completion.

Note: Any student has a right to file a request with the Registrar's Office that some or all of this information not be published or disseminated except as required by Federal or State statutes or necessary to a basic function of the school. Please contact that office to file such a request.

Form of the Graduate School of Biomedical Sciences

University of Massachusetts Medical School

Last Updated: 12/4/2013

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GSBS_59_non_degree_info.doc