YOUR INFORMATION First Name : Middlle Name : Last Name : Birth/Maiden Last Name : Date of Birth : Gender : Address : City : State : Zip Code : County (PA only) : Email : Phone : Emergency contact name and telephone : Are you a new student? Yes No Student ID Number : Professional Personal ID (PPID from PDE) : Required for PA Certified teachers who would like Wilson College to report act 48 credits to PDE. Wilson College reports only courses completed for credit at the college. Students must have a grade of 'C' or better in the course for it to be reported as meeting Act 48 requirements. Determining if this course credit actually satisfies Act 48 requirements is not the college's responsibility. Student Classification : - Select -Will be applying for acceptance to program / earning degreeOfficially accepted to programNon-Degree Do you require handicap accessibility? Yes No Please list your anticipated graduation year and semester : Employer (School District) : Position : RACE/ETHNICITY The Federal Government requires that Wilson College reports student race/ethnicity information as part of our annual data collection. The information will not in any way be part of the institution’s admission process and decision with regard to the applicant. What is your ethnicity? Hispanic or Latino Not Hispanic or Latino What is your race? (Please check all that apply.) : American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaskan Native asian Are you a U.S. citizen? Yes No If you are not a U.S. Citizen, please list your Country of Citizenship, Type of Visa, and Country of Birth. There is no need to provide Ethnic Background. COURSE REGISTRATION 1. Course Number and Section : Course Title : Course Type : Online Cohort Year and semester for which this registration applies : 2. Course Number and Section : Course Title : Course Type : Online Cohort Year and semester for which this registration applies : 3. Course Number and Section : Course Title : Course Type : Online Cohort Year and semester for which this registration applies : 4. Course Number and Section : Course Title : Course Type : Online Cohort Year and semester for which this registration applies : DEFERRED PAYMENT OPTION Students may elect to defer their tuition payment by accepting the online Deferment Agreement available through their MyWilson Portal Self Service. The Deferment Agreement must be accepted for EACH TERM during which student would like to choose this option. There is a non-refundable Deferred Payment Fee of $50.00 per 16-week semester for the convenience of deferring payment. A link to the Self-Service Deferment Agreement Acceptance instructions is listed on the right-hand side of the MMCL program webpage. New students that are registering for their first graduate course can choose this option after the course registration has been processed, and MyWilson portal login information has been provided. FINANCIAL CONSENT AGREEMENT Wilson College requires all students to have a completed Financial Consent agreement on file. Effective the Fall 20 semester, students are required to review and accept the new Financial Consent agreement through their MyWilson Portal Self Service. Course registrations cannot be processed until the agreement has been accepted. Please take a moment to log on to your MyWilson portal and accept this agreement. There is a link on the MMCL webpage (below the registration link), that lists step-by-step instructions. You may contact the One-Stop Student Services Center (ssc@wilson.edu) if you have difficulty accessing and/or completing the agreement. Students that are registering for their first graduate course must accept the Financial Consent Agreement after their course registration has been processed, and MyWilson portal login information has been provided. I have completed the new online Financial Consent Agreement (effective Fall 2020) Yes No WILSON TERMS AND CONDITIONS / DEFAULT OF FINANCIAL OBLIGATIONS It is the student's responsibility to inquire to the Office of Financial Aid to determine if she/he qualifies for Financial Aid for this semester. Please contact the Business Office with questions concerning payment. All payments must be made to the Business Office. *I agree that in default of any financial obligation to Wilson College, I agree to pay all costs and expenses incurred by Wilson College, including collection agency costs and reasonable attorney fees, in collection of any sum that is due. *If agree that if I owe a financial obligation to Wilson College, Credit Bureau reports may be reviewed by collection agencies. *I understand that in the event of default that academic transcripts and grades will not be released until the debt is paid in full. *By agreeing and submitting this form, I agree that the above information is correct, and confirm my understanding of the Financial Obligation as described above. I agree that the information entered into this form is correct, and understand my Financial Obligation as described above. I agree Submit Leave this field blank
