REGISTRATION FORM

REGISTRATION FORM
Degree Program
University of Washington
Professional & Continuing Education
Executive Master of
Public
Administration
UW Professional & Continuing Education Registration Services, PO Box 45010
Seattle WA 98145-0010 Fax (206) 685-9359, Phone (206) 543-2310
IMPORTANT - PLEASE READ - THIS IS NOT A BILL
KEEP A COPY OF THIS FORM FOR YOUR RECORDS
UW - Seattle campus
* Registration is not final without payment.
* Return this form and payment to the above address or register by telephone using VISA or
MasterCard by calling (206) 543-2310 Monday through Thursday 8:00 a.m. to 5:00 p.m. and Friday
9:00 a.m. to 5:00 p.m.
Winter 2015
Second Term: 01/05/2015 - 03/20/2015
PERSONAL INFORMATION
_________________________ _______________ _______________ _______________
Name (Last)
(First)
(Middle)
Birthdate
_________________________ _______________ _______________ _______________ _____________________
Address
City
State
Zip Code
UW Student ID No. (Required if
you have ever enrolled at UW)
_________________________ _______________________________ _____________________________________
Day Phone
Evening Phone
E-mail
__________________________________________________________________________ _____________________
Signature (I acknowledge I have read and understand all fee/policy information below.)
Please check: Yes ‰ No ‰ I am active U.S. military or a U.S. military veteran.
‰
Date
I will seek reimbursement from the GI Benefits Office.
COURSE(S)
Course Information on Back
METHOD OF PAYMENT
Please check the box that indicates your payment method:
‰ Credit Card. (Provide card information at right.)
‰ Enclosed check made payable to the University of Washington.
(Returned checks are subject to $25 service charge.)
‰ Third-party payer - Separate document (purchase order or letter of
authorization to bill) must accompany registration form each term.
‰ Third-party payer authorization on file.
‰ Approved or pending Financial Aid - UW Professional & Continuing
Education Payment Agreement must accompany registration form
each term.
‰ VISA
‰ MasterCard
___________________________________________ _________________
Credit Card Number
Expiration date
______________________________ ______________________________
Print name as it appears on card
Signature
_____________________________________________________________
Credit card billing address (if other than student address)
_____________________________________________________________
Phone number
FEES / POLICIES
PAYMENT POLICY: Payment (or, for students receiving financial aid, the UW P&CE Payment Agreement) is due at the time of registration. There is a
$25 late fee beginning the first day of the term: January 5, 2015. Students receiving financial aid through the UW Student Financial Aid Office must pay
in full within one week after the financial aid has been disbursed. There is a $75 petition fee beginning January 19, 2015.
REFUND POLICY: To receive a 100% refund, minus the $44.00 nonrefundable registration fee, you must send a written request to withdraw by January
11, 2015. To receive a 50% refund, minus the $44.00 registration fee, the written request must be received by February 3, 2015.
WITHDRAWAL POLICY: If you are not planning to continue in the program or course, please send a request to withdraw, with or without a refund, to:
UW Professional & Continuing Education Registration Services, PO Box 45010, Seattle WA 98145-0010, or send email to [email protected]
OTHER MANDATORY FEES: Information about other mandatory fees is available on the web at http://f2.washington.edu/fm/sfs/tuition/components.
ACCOMMODATIONS FOR DISABILITIES: To request disability accommodations, contact the UW Disability Services Office as early as possible at
206-543-6450.
CANCELLATIONS AND CHANGES: UW Professional & Continuing Education reserves the right to cancel programs or classes with low enrollment.
Fees and tuition are subject to change.
PARKING: Parking information and maps are available on the web at http://pce.uw.edu/resource.aspx?id=3846.
Course Information
THESIS (required of all students)
Registration #145649 Master's Thesis (BCWRIT 700 A)
To Be Determined: 01/05/2015 through 03/20/2015
Academic Credits: 5.00
Faculty Code required_________
Tuition:
$2,850.00
Please contact Kate Osmond, [email protected] to obtain faculty code for your thesis adviser
BCWRIT ELECTIVE COURSES (please select)
Registration #146025 Teaching Practicum (BCWRIT 517 A)
To Be Determined: 01/05/2015 through 03/20/2015
Academic Credits: 3.00 - 5.00, please specify:
Tuition: $570.00 per Academic Credit X
Faculty Code Required __________
Academic Credits
$
Please contact Lisa Olason, [email protected] to discuss registration procedures and obtain forms
Registration #145646 Internship (BCWRIT 520 A)
To Be Determined: 01/05/2015 through 03/20/2015
Academic Credits: 2.00 - 5.00, please specify:
Tuition: $570.00 per Academic Credit X
Faculty Code Required__________
Academic Credits
$
Please contact Lisa Olason, [email protected] to discuss registration procedures and obtain forms
Registration #145647 Directed Research (BCWRIT 598 A)
To Be Determined: 01/05/2015 through 03/20/2015
Academic Credits: 2.00 - 10.00, please specify:
Tuition: $570.00 per Academic Credit X
Faculty Code Required___________
Academic Credits
$
Please contact Lisa Olason, [email protected] to discuss registration procedures and obtain forms
OTHER COURSES (optional)
 Course #
SLN#
# of Credits
Graduate Tuition:
$570 x
=$
Course Title
Entry Code Required
 Course #
(credits)
SLN#
# of Credits
Graduate Tuition:
Course Title
$570 x
 Course #
=$
(credits)
Entry Code Required
SLN#
# of Credits
Graduate Tuition
$570x
=$
Course Title
(credits)
Entry Code Required
Registration Fee:
$44.00
Technology Fee (Select appropriate fee from the chart below):
$_____
Other Mandatory Fees (Select appropriate fee from the chart below):
$_____
Total:
$
_
Credit Course Fees*
Number of Credits
Technology Fee- Graduate
1
2
3
4
$12 $12 $18 $24
5
6
7
8
9
10+
$30
$36
$42
$42
$42
$42
Other Mandatory Fees- Graduate $46 $46 $69 $91 $114 $137 $160 $160 $160 $160
* Subject to change without notice