Ivory Form -Traditional
Student ID# or SS#:
Student's Current Address (Be Sure to include apartment #):
Home Telephone #:
Cell Phone #:
Parental/Guardian Email Address (optional):
Intended Area of Study/Academic Interest:
Name to be printed on Diploma:
Citizenship (for example: U.S.):
Are You a Permanent US Resident?:
Eastern University offers optional services for first generation students. Check this box if NEITHER of your parents have GRADUATED from college
Scheduling Constraints -
If you play on a college sports team, have an off-campus
job, commute from a distance, or have other scheduling
limitations, list that information here. Please include any
unavailable times and a short explanation. The Registrarís
Office will try to work around your time constraints, but
cannot guarantee all requests.
SPECIAL NOTE: Please be aware that section number and time requests may not be honored due to course closures, prerequisites, time conflicts, and/or major choices. In the event that your requests are not honored, another section of the same course or a different course may be substituted. The Registrarís Office will create a schedule based on your mandatory courses, course preferences, and intended area of academic study.
of this registration form obligates you to pay tuition and fees for all courses
for which you are registered at the beginning of the academic session.
Notification of registration change or cancellation must be submitted in
writing to the Registrar.
submitting this form you indicate that you are the person named above, and you
have read all
the information provided.