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Boston University
LAST NAME

REGISTRATION FORM
B.U.I.D. / SOCIAL SECURITY NUMBER EMAIL ADDRESS: MIDDLE INITIAL DATE OF BIRTH MO. DAY YR. M = MALE F = FEMALE SEX

OFFICE OF THE UNIVERSITY REGISTRAR

COLLEGE

FIRST NAME

MARITAL STATUS D - DIVORCED S - SINGLE M - MARRIED W - WIDOWED

ACADEMIC SEMESTER
(CIRCLE ONE) YEAR

FALL

SPRING 20______

Students are reminded that in accordance with the Code of Student Responsibilities (Appendix 15), current addresses must be on file with the University. STREET & CITY H O M E A D D R E S S L O C A L A D D R E S S STREET & CITY

IF LOCAL ADDRESS IS DIFFERENT FROM HOME, FILL IN LOCAL ADDRESS

STATE

ZIP

COUNTRY (IF FOREIGN ADDRESS)

STATE

ZIP

LOCAL PHONE

PRIMARY CONTACT PHONE

COUNTRY OF CITIZENSHIP (FOREIGN STUDENTS ONLY)

RELIGIOUS / DENOMINATIONAL PREFERENCE (CIRCLE ONE)

ABCDEFGHJBAPTIST BUDDHIST CHRISTIAN SCIENTIST CONGREGATIONALIST EPISCOPALIAN HINDU JEWISH EVANGELICAL CHRISTIAN LUTHERAN KLMNOPQRSMETHODIST MUSLIM EASTERN ORTHODOX CHRISTIAN PRESBYTERIAN UNITED CHURCH OF CHRIST ROMAN CATHOLIC EARTH-BASED (PANTHEIST) UNITARIAN UNIVERSALIST ASSEMBLIES OF GOD TUVWXYZBAHAI LATTER-DAY SAINTS SIKH OTHER (CHRISTIAN) OTHER (NON-CHRISTIAN) NO PREFERENCE NOT LISTED

ETHNIC CODE (CIRCLE ONE)

(REQUIRED FOR GOVERNMENT REPORTS) A - AFRICAN AMERICAN/BLACK B - AMERICAN INDIAN/ ALASKA NATIVE C - ASIAN D - WHITE E - NATIVE HAWAIIAN/ PACIFIC ISLANDER F - LATINO/HISPANIC G - OTHER H - NO INFORMATION

HOME PHONE

WORK PHONE

PERSON TO NOTIFY IN A PERSONAL EMERGENCY RELATION PHONE

P - PARENT S - SPOUSE G - GUARDIAN O - OTHER

BU EMERGENCY ALERT CONTACT PHONE (NOTICE OF UNIVERSITY-WIDE EMERGENCY) ADDRESS

H - HOME L - LOCAL P - PARENT O - OTHER

MARK IF CELL PHONE

COLLEGE

COURSE NUMBER

SECTION

CREDIT HRS

AUDIT

DAYS

TIMES

COURSE TITLE

EX. 1 2 3 4 5 6

CAS

CS

101

A1

M-R

9-11:00

INTRODUCTION TO COMPUTERS

ALTERNATIVE CLASS SELECTION(S) PLEASE SELECT ALTERNATIVE CLASSES TO ENSURE THAT YOU RECEIVE A COMPLETE SCHEDULE. INDICATE BELOW WHICH OF THE ABOVE CLASSES MAY BE SUBSTITUTED BY PLACING THE NUMBERS 1-6 IN THE FIELD MARKED ALT. NO
ALT NO. COLLEGE COURSE NUMBER SECTION CREDIT HRS AUDIT DAYS TIMES COURSE TITLE

1974 Privacy Act Restrict Box. Check to restrict. See reverse side to restrict specific data. Visit the Registrars Office home page at www.bu.edu/reg to view an updated version of the Class Schedule.
STUDENTS SIGNATURE AND DATE ADVISOR SIGNATURE AND DATE IF REQUIRED BY YOUR SCHOOL

View your academic record, register, add and drop classes, change your address or confirm your registration on the Student Link at www.bu.edu/studentlink/

Family Educational Rights and Privacy Act

The Family Educational Rights and Privacy Act ensures confidentiality of your educational records and restricts disclosure to or access by third parties, except as authorized by law. You have the right to inspect your educational records, with certain exceptions. If you wish to inspect your records, you need to submit a formal request to the University Access Officer in the Registrars Office. An appointment will be made within 45 days of the date of the request. If you believe your educational records are inaccurate or misleading, you may request an amendment. If you wish to request an amendment, you need to complete the appropriate form available from the University Registrars Office. If it is determined that the record will not be amended, you will be notified of your right to, and procedures for requesting, a hearing. The University has designated certain types of personally identifiable information as Directory Information. This includes your name, local address and primary contact phone number, email address, college of registration, degree program and major and minor, dates of attendance, full- and part-time status, and degrees, honors, and awards received. Your local address and primary contact phone number are accessible on the electronic directory which can be used by the University community. If you wish to restrict the release of this information at any time, you may do so by using the Student Link, by completing the form below or by visiting the Office of the University Registrar. The Student Activities Office (Associate Director, GSU, 775 Commonwealth Avenue) and the Athletics Department (Director, 285 Babcock Street) may release information on students who participate in officially recognized activities and sports. If you wish to restrict the release and/or publication of this information, you should contact the Student Activities Office and the Athletics Department directly. The University, in compliance with the law, will disclose personally identifiable information without your prior consent under certain circumstances, including, but not limited to, the following: a) To University officials, staff, and others engaged in activities on behalf of the University; b) In compliance with a lawful subpoena; c) To officials of another institution where you are enrolled or seek to enroll, or where you received services in connection with placement or participation in internships practica, affiliations and other programs related to your courses or program at the University; d) To authorized representatives of institutions from which you have received financial aid or applied to for financial aid. The University reserves the right to provide grades and access to educational records to the parents of financially dependent undergraduate students, as defined in section 152, 1954 Internal Revenue Code. The University assumes its full-time undergraduate students are financially dependent unless the parent or student informs the University Access Officer otherwise. You have the right to file a complaint with the U.S. Department of Education Family Policy and Regulations Office, Federal Office Building, Number 6, Room 3021, Washington, DC, 20202, if you believe that Boston University failed to comply with the Acts requirements.

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If you wish to restrict the release of your Directory Information, you may do so by using the Student Link, by completing the information below, or by visiting the Office of the University Registrar. Name: _________________________________________ Check to restrict: ___ ___ ___ ___ ___ ___ Academic program (degree, major, minor) Dates of attendance, Full / Part-time status Degrees, honors, and awards received Email Directory Look up Local address and primary contact phone number School or College Please return to: Boston University Office of the University Registrar 881 Commonwealth Avenue, 2nd floor Boston, MA 02215 Phone: 617-353-3612 Fax: 617-358-1689 BUID or SS Number: ___________________________________

Signature: _____________________________________

Date: _________________________