Print this form, then complete all items and send to:

University of Wyoming
Correspondence Study
Department 3294
1000 E. University Ave.
Laramie, WY 82071
Ph: 800-448-7801  Fax: 307-766-4048


--- USE THIS FORM ONLY FOR CORRESPONDENCE STUDY COURSE REGISTRATION ----

(Please note: Lessons can be mailed to P.O. Box addresses, however, the study packets
is sent via UPS ground shipping and requires a street address. If alternate shipping
arrangements are required please call the Correspondence Study offices
for assistance.)

SSN or W Number:______________________________ Date:_____________

Date of Birth:_____/___/______ Gender: ___Male ___Female  

Legal Name:_____________________________________________________________________________

Mailing Address:________________________________________________________________________ 

Street Address:_________________________________________________________________________

City:_______________________________________State:_________________Zip:________________

Phone Number(day):(____)_____________e-mail:_________________________________


If current university student, name of university attending:_____________________________

Class standing:______________________Major:______________________________________________

Dept./Course		Course Title			Credit	Prereq.	Fee
(ex. HIST 1110)						Hours	Met

_______ ________	___________________________	______	_____	________

_______ ________	___________________________	______	_____	________

_______ ________	___________________________	______	_____	________

Delivery Fee: $15 per credit hour (nonrefundable)			________

A/V material and/or books						________

								TOTAL	________

Tuition: $94 per credit hour
Delivery Fee: $15 per credit hour
Make checks payable to the University of Wyoming


Visa____MasterCard____Credit Card#: _________________________________________________

Exp. Date ____/_____

Name on Card:___________________________________Signature:______________________________

Billing Address for credit card if different from mailing address:

Street:_______________________________________________________________________________

City:___________________________________State:_________________Zip:__________________

Check(#_______________________)

It is your responsibility to obtain your advisor’s approval before enrolling in any
course(s) that you plan to use toward a University of Wyoming degree. Enrollment in a
correspondence study course does not constitute admission to other programs at the
University of Wyoming. Correspondence study course credits may or may not be used toward
a specific major after you have been admitted to the university. If you are on academic
probation/suspension and expect to use credits earned through correspondence study as
evidence that you can handle university work, obtain approval from the associate dean
of your college. All enrollees are responsible for knowing the rules and regulations
in the correspondence study course schedule and in the general information sheet
(pp. i-ii) in the course syllabus.

I have read and understand the above statements. Signature:______________________________