Social Security Number:	Last Name:	First Name:	Middle Initial:
Street address:		City: State: Zip: Country:
Home Phone (with area code):		E-mail:
Sex: Female Male	Date of Birth:	Dorm (if applicable):	Major (if applicable):

Student Status (please check one from each of A and B):
A: Undergraduate Graduate	B: Continuing Re-Admit New Freshman or Grad New Transfer Visiting Special

Visiting students who wish to have a transcript of their Southampton record sent to their home school at the end of the Summer Session should apply at the Registrar's Office as soon as possible.

Please complete all information below, grouping courses by session number
(06 = Session I, 07 = Session II, 16 = Institutes, Workshops and Special Sessions):

Session	Discipline	Course #	Section	Credits	Audit	P/F	Conflict
06 07 16
06 07 16
06 07 16
06 07 16
06 07 16
06 07 16

Visiting and Special Students please complete:

Is this your first time enrolled at any college? Yes No If No, do you hold a baccalaureate degree? No Yes

If you are currently attending another college or university, please fill in the name and address of your home school:

School:
Street address:	City: State: Zip: Country:

Please mail us the following:

1. Approval of registration from your home school
2. Your Advisor's Signature:
3. Your Signature:

Your signature authorizes your registration for summer school. A bill and schedule will be issued and forwarded to you by mail. If you fail to cancel your registration prior to the first class session you will be held financially liable and subject to the refund schedule in effect for this program. Program changes, drops, adds or withdrawals must be done in writing to the Registrar's Office. Your enrollment at Southampton Graduate Campus in no way implies matriculated status in a degree program.

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