Non-matriculated Student Registration Form

Proof of pre-requisites may be required to confirm your registration; you will be notified if a transcript is needed. You will receive a statement of account for payment shortly following receipt of this form.

First Name

Middle Initial

Last Name

Address Line 1

Address Line 2

City

State

Zip

Email

Mobile Phone

Date of Birth

SSN

Registration Request

Please include the course code below for the course or courses you would like to take. Please include the department code, course number, section number and location code, example: RLST 104 01 M. You can search for courses via the Schedule of Classes feature on myCHC.

Course 1

Course 2

Course 3

Are you registering for this course(s) through the Lifelong Learning on the Hill program?

Are you currently a high school student?

High School Name

Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from ninth grade forward, whether related to academic misconduct, probation, or dismissal, or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution

Please provide information regarding the incident(s), including date(s) and explanation(s) of the circumstances.

Have you ever been convicted of a misdemeanor, felony or other crime, or do you have any such charges pending?

Provide information regarding the incident(s), including date(s) and explanation(s) of the circumstances. Depending on the responses below, the College reserves the right to request additional information and/or require a criminal background check, at the applicant's expense.

Please Check

I am aware that this application is for enrollment in undergraduate courses as a non-matriculated student at Chestnut Hill College.

I have checked with my current institution to ensure this course meets any requirements.

I am aware I am responsible for all financial obligations related to the courses indicated on this application.

If I wish to DROP or WITHDRAW, I understand I must comply with the deadlines as they appear on the academic calendar.

If I wish to have these courses reported to a home institution, I will make a transcript request in writing and pay the associated transcript fee.

I understand I must comply with all student-related policies as described in the Academic Catalog and the Student Handbook (both available at www.chc.edu.)

Student Signature

Date

Parent/Guardian Signature (if under 18)

Date