IELP ESL Registration Form for UAlbany Students

Please complete all information below. For more information, see the course description: http://www.albany.edu/ielp/ESLCourses.html

Check the course(s) for which you are registering:
1. Name: ________________________________________________________________________
          (first)                      (last / family name)

2. Albany ID#:  _________________________________________________________________
   (REQUIRED)

3. Semester: ________Fall   ________Spring    ________Summer
 
4. Local Address:      __________________________________________________________

                       __________________________________________________________

   Telephone #:        (DAY)____________________(EVENING)________________________

   Email address:      __________________________________________________________

   Your 1st / native language: __________________________________________________
  	Visa Status:  _______________															 
	Date of Birth:(month/day/year)______________________________________
5. Department:                 __________________________________________________
   Department Address:         __________________________________________________
   Advisor's Name:             __________________________________________________
   Advisor's Tel. Number:      __________________________________________________
   How many credit hours are you currently taking this semester? ________________
   Student Status:   ____Undergraduate  ____Graduate  ____Other: _________________
   TOEFL Score:  ________

6. HOW and WHERE did you learn about this class?
   _______________________________________________________________________________
7. Questions or Comments: ________________________________________________________

   _______________________________________________________________________________

----------------------------- For Office Use Only ---------------------------------
Paid: $_______________UAorRF. Date:__________   Date Posted_______To be Posted____

Notes/Comments: __________________________________________________________________

__________________________________________________________________________________
----------------------------- For Office Use Only ---------------------------------

Complete printed form and mail with a check to:
IELP, Science Library G14, 1400 Washington Ave., Albany, NY 12222
Check should be made payable to: University at Albany.
Load equivalency policy: 80% attendance is required.