Distance Learning Courses Online Registration Form
Summer semester, 2016

Third parties may NOT register incarcerated students via this online form. Please go to the Prison College Program section to print a registration form.

fields marked with a * are required

Name (First,Middle,Last): *      *
Current Mailing Address
Street Line 1 *
Street Line 2
City*
State*
Zip Code*  Phone number: (No Dashes)
Nation :
Permanent (Home) Address
Street Line 1
Street Line 2
City
State
Zip Code
Nation :
Personal Information
Email Address*
Date of Birth:  *
Gender (M/F)*

If you have taken classes at ASU previously and know your ASU ID (a 9 digit number that starts with 900), enter it here - otherwise leave this field blank.
ASU ID number:
Your SSN is used for tax purposes only and is *not* used as a personal identifier.
SSN (with no dashes):
Ethnicity Information.
Ethnicity Code:


The following Selective Service question must be answered to comply with the Colorado State Law:
If you are a male born after December 31, 1959, by checking this box you certify that you are registered with the Selective Service.


Please Select the highest degree that you have been awarded (Bachelors Degree required to take courses for Graduate Credit)
Select from the drop down list: *

ONLINE COURSES: An e-mail with instructions will be sent 3-5 business days after registration AND payment are made

PRINT BASED COURSES: An e-mail with a link to a study guide will be sent 3-5 days after registration AND payment are made

Please Select the course(s) you would like to register for (NOTE: registration for more than one semester may be open at any given time)
Enter a string to search on to limit the number of courses listed (not case sensitive):





















































































































































































































































How did you hear about our courses?

Please enter any of these that apply - ASU Distance Degree Student, ASU Mobile Campus Student, ASU On-campus Student, or a HS Student desiring college credit.

The studyguide for print based courses will be available for you to print online unless you indicate below that you would like to have it sent by mail


Statement of Certification

By selecting that you agree, you are certifying that you are the person who has completed the information furnished on all sections of this application. You are certifying that to the best of your knowledge, the information furnished is true and complete. You understand that if found to be otherwise, it is sufficient cause for delay of admission, loss of credit, rejection or dismissal. You also understand that by enrolling in courses at Adams State University you are subject to all academic policies as they relate to your enrollment including but not limited to the Academic Integrity Policy 100-03-01.

For more information regarding Academic Integrity, please go to http://www.adams.edu/extended_studies/undergrad/academic-integrity.php

*I understand that by submitting this information via electronic transmission that I acknowledge the above in lieu of a signature*


Comments:

By completing registration for this semester I am entering into a legal binding contract with Adams State University (ASU) to pay all tuition, fees and related expenses, including late fees. I accept full financial responsibility for each registered course. I authorize ASU, the Extended Studies department, and their respective agents and contractors to contact me regarding my loan, student account or any balance owed to ASU at the current or any future number either provided or acquired for my cellular phone or other wireless device using automated telephone dialing equipment or artificial or pre-recorded voice or text messages or e-mail address either provided or acquired and/or the ASU student e-mail address I am provided by the institution. Past due balances are subject to placement with a collection agency. I agree to reimburse ASU the fees of any collection agency, which may be based on a percentage of debt up to 40%, and all costs and expenses, including reasonable attorney's fees ASU may incur in such collection efforts in accordance with Colorado statutes. ASU may also certify to the Colorado Department of Revenue my name, social security number, amount of debt, and other identifying information required by the Department for collection of my debt from the tax rebate amounts owed to me, if any. C.R.S §23-5-115

 
To pay by credit card, please select the 'Credit Card' option and press the Submit button. If you would like to print an invoice and mail in a check or money order, select the Mail In Check or Money Order option and press the Submit button to generate a printable invoice.

Attention ASU Degree Seeking Students: A matriculation fee of $100 will be assessed to your ASU Student account upon submission of your first course registration. This one-time only fee will appear on your bill and will be assessed one-time during your entire academic career at ASU.
 

 

 

 

To use financial aid for this course, you must have applied and qualified for aid. In addition, prior to your financial aid being disbursed, you must print, read, sign and return the Financial Aid Policies document for distance students located HERE You will be required to sign and submit a new document to the Financial Aid office for each financial aid year.