Non-Degree Course Registration Form - Form N - American University of Cote d’Ivoire

This is a course selection form for the ESLU, ESLP, TOEFL and GED programs. This form will be used at a later date when the distant learning technology becomes available. FRENCH: Formulaire de selection de cours dans les programmes de ESLU, ESLP, TOEFL et GED. Ce formulaire sera utilisé à une date ultérieure quand la technologie des cours à distance sera disponible.

Personal Information

Student I.D. #

National I.D. #

Diploma or Degree Obtained (Please indicate)

Program of Study

English for University Preparation- ESLU
English for Personal & Professional Development-ESLP
GED /BAC Américain
TOEFL- Test of English as a Foreign Language
Other (specify)

Other

Name

First Last

Date of Birth / Date de Naissance

Place of Birth / Lieu de Naissance

(City/Village & Country)

Gender

Male
Female

Domicile

(City & District)

Email*

Cell Phone*

Home Phone (if any)

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Student Class Schedule

Please select courses from this session course list

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Course Number/Section/Title

Meeting Days & Times

Time Frame / Instructor

Course Cost

Total Cost to Pay

Submit

*VERY IMPORTANT: It is the responsibility of the student that the completed form is received by the Registrar’s office for processing and that payment is made in a timely manner. Please refer to the Academic Calendar for payment Due Date and Refund deadlines.

*Students who wish withdraw from either a course or the College must receive official authorization from the Registrar’s Office. Failure to withdraw officially may result in the recording of an F grade for credit courses and Un-satisfactory notation for non-degree courses. A student who is asked to leave the College for misconduct or many unexcused absences will receive no refund of tuition or fees.

In consideration of this registration and enrollment at the American University of Cote d’Ivoire (AUCI), I, the undersigned student (or parent of a minor), do hereby agree to assume and PAY any and all tuition costs and charges including collection costs and attorney fees for unpaid tuition and other charges.

Signature

Print full name as an indication of acceptance.

Advisor Signature

Required only for a full time student.

Date

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