Duke University Summer Session
APPLICATION / REGISTRATION FORM

To be completed by:

Visiting Students, Graduating Duke Seniors, & Incoming Duke First Year Students

Return completed registration form to:

Duke Summer Session Office
Box 90059
Durham, NC 27708-0059

Or FAX: 919/681-8235

Visiting Student:      [  ] Pre-baccalaureate      or      [  ] Post-baccalaureate

Have you previously attended Duke?      [  ] No      [  ] Yes, date(s)__________________________

Have you received a degree from Duke University?      [  ] No      [  ] Yes

If yes, date and type of degree________________________________________________

Duke Student:      [  ] Graduating Duke Senior      [  ] Incoming Duke First Year Student

[  ] Ms.      [  ] Mr.      [  ] Dr. ________________________________________________________
                                                       first                      middle initial               last name

Social Security Number: __________ -- __________ -- __________

Citizenship _________________________      Ethnic Origin _________________________

Date of Birth: __________ -- __________ -- __________

Current Mailing Address: ________________________________________________________
                                          street                                    city                     state     zip code

Telephone: (____) ____________________ Fax: (____) ____________________

Email address: _____________________________________________________

Permanent Address: ____________________________________________________________
                                      street                                    city                     state     zip code

Telephone: (_____) ___________________

 

Please register me for the following course(s).

Term I:     Course Number       Course Name                                       For Credit         For Audit

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Term II:    Course Number       Course Name                                       For Credit         For Audit

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Next of Kin: ___________________________________________________________________
                                     name                                                                           relation

Address: ______________________________________________________________________
                    street                                               city                            state      zip code

Telephone: (____) ____________________ Fax: (____) ____________________

Email address: _____________________________________________________

I.    Are you currently enrolled as a college student?

[  ] YES (name, city, and state of the institution): ____________________________________

Are you a candidate for a degree?   [  ] No     [  ] Yes, type: _________________________

Expected date of graduation? ________________________________________________

Are you on any type of academic or disciplinary probation at the above institution?  
[  ] No.
[  ] Yes. If yes, explain: _____________________________________________________

___________________________________________________________________________

 

II.  If you are not presently enrolled, have you attended college in the past?

[  ] Yes, degrees held: ______________________________________________________

Name(s) of institution(s) attended, location of institution, and dates attended:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Were you on any type of academic or disciplinary probation at the time you left any of the institutions above?

[  ] No.
[  ] Yes. If yes, explain: _____________________________________________________

___________________________________________________________________________

III. I have been accepted to begin my college education this fall at: ______________________

___________________________________________________________________________

(Please attach a copy of your admissions offer.)

 

IV. I affirm that all of the information on this form is complete and correct. I have also read the sections on "Tuition and Fees," "Payment of Tuition and Fees," "Adding," "Drop/Add," and "Dropping, Withdrawal, and Refunds" and understand my obligations, including financial penalties I may entail.

___________________________________________ _________________________
signature                                                                                 date