APPLICATION

APPLICATION / REGISTRATION FORM

SUMMER 2017

Application to be completed by: Summer-Only (non-degree seeking) Students

Application must be typed (not handwritten). Please print the application and sign as directed.

Return completed application with nonrefundable application fee to:

Tulane University
Summer School
Cudd Hall
Suite 201
New Orleans, LA 70118

The application fee of $25.00 is payable by check, money order, or credit card. This fee is non-
refundable.

I want to pay by credit card.

Credit card number Name on card Expiration

I have enclosed a check or money order payable to Tulane University.

Visiting Students:. Pre-baccalaureate or Post-baccalaureate

Have you previously attended Tulane? No or Yes
Date(s):
Did you receive a degree from Tulane University? No or Yes
If ‘Yes,’ date and type of degree:

Your Summer School application is considered complete and ready for review only when you have submitted the
following:

This completed application form

$25 application fee

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Applicant Current Information:

Given/First Name Middle Name Surname/Last Name

Preferred First Name

Number & Street City

State/Province Country Postal Code

Telephone

E-mail Address

Confirm E-mail Address

Male Female Single Married

Date of Birth (M-D-Y): -- -- Social Security Number: -- --

Country of Citizenship:

Ethnicity (optional):

I choose to specify from the following ethnic groups:

Hispanic or Latino Black/African American White Native American/Alaskan

Asian Native Hawaiian/Pacific Islander Other

I choose not to specify.

Permanent Address:

Number & Street

City State/Province

Country Postal Code

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Emergency Contact/Next of Kin:

Name

Number & Street City

State/Province Country Postal Code

Telephone E-mail Address

I am interested in taking the following course(s)

1.
Course Number Course Name
2.
Course Number Course Name
3.
Course Number Course Name
4.
Course Number Course Name

*PLEASE NOTE: You may only enroll in ONE Maymester course in the same term.

Primary reason for attending Tulane Summer School:

Please complete section I or II or III, depending upon your current status. All applicants must
complete item IV.

I. Are you currently enrolled as a student in a U.S. institution?

Yes No

Name, city, and state of institution

Are you a candidate for a degree? No Yes, type:

Expected date of graduation?

II. If you are not presently enrolled, have you attended college in the past?

Yes, degrees held, if any:

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Name(s) of institution(s) attended, institution location(s), and dates attended:

III. I have been accepted to begin my college education this fall at:

IV. Have you ever been placed on any type of academic or disciplinary probation at any of the institutions above?

No.
Yes. If yes, explain (here or on a separate sheet of paper):

The Tulane Academic Code. Tulane University is a community dedicated to scholarship, leadership, and
service and to the principles of honesty, fairness, respect, and accountability. Citizens of this community
commit to reflect upon and uphold these principles in all academic and non-academic endeavors, and to
protect and promote a culture of integrity.

VI. **I affirm that all of the information on and associated with this form is true and complete and that if any of the
information changes between now and my enrollment at Tulane I will notify the Summer School Office.

**I commit myself to uphold the Tulane Academic Code and the University policies that proceed from it and
understand that failure to do so may result in disciplinary action, up to and including dismissal from Tulane
University.

Signature Date

Return completed application to:

Tulane Summer School

Cudd Hall, Suite 201
New Orleans, LA 70118
Phone: 504-865-5720
Fax: 504-865-5236
summer@tulane.edu

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http://summer.tulane.edu/