UNITE REGISTRATION SHEET
to Enroll through UNITE Distributed Learning
PERSONAL INFORMATION
* Indicates this is a
required item
Last Name * First
Name *
Preferred Name
University of Minnesota Student ID Number (if you
have one)
E-mail Address (University of Minnesota email address,
if you have one)*
DEMOGRAPHIC INFORMATION
City *
State *
Zip Code *
FOR THOSE ENROLLING THROUGH UNITE FOR THE
FIRST TIME:
If this is your first enrollment in a University of
Minnesota course through UNITE, how did you hear about
the UNITE program?
Please tell us more about how you learned about UNITE
Distributed Learning (200 character limit):
COURSE REGISTRATION
If you are already enrolled in an on-campus section of
a course and are using this form to CHANGE
your registration to a UNITE section of that/those
course(s), please tell us which course(s):
UNITE Course Enrollment
Select Term:
Grade Option: A-F -
Standard Letter Grade, S-N -
Satisfactory/Unsatisfactory, AUDIT - Visitor/No Credit
If you are registered for other UNITE course(s) in
same semester, check here:
If you are registered or plan to register for
on-campus course(s) for in same semester, check here:
If submitting this form PRIOR to your assigned
University of Minnesota registration queue, what
date/time is your assigned registration queue for same
semester?
(UNITE has to hold registrations until a student's
assigned registrations queue - you may submit this
registration to UNITE and we will hold it until we may
enroll).
UNIVERSITY OF MINNESOTA INFORMATION
Select your enrollment status for this UNITE
registration:
IF admitted to University of Minnesota Graduate or
Undergraduate Program, which program/major?
EXAM AND QUIZZES
For courses with exams and/or quizzes,
UNITE-enrolled students are required to take the exam with a
UNITE-approved proctor on the same day/same time as the
on-campus section of the course (see Exam
Information for UNITE-Enrolled Students).
For this enrollment, what is your exam plan for
courses through UNITE?
Only instructors may grant permission to
time-shift an exam time or to take the exam with the on-campus
section. UNITE can not approve any modifications to this
policy.
* By checking this box, I understand
and agree to abide by the UNITE Exam Policy.
(CHECK HERE)
TRAVEL DURING SEMESTER
Enrollment through UNITE is limited to
students who are located in the United States during
the semester for which they are registering.
Short-term travel during the semester will require
instructor and UNITE approval in the event of exams.
* By checking this box, I
understand and agree to this Location & Travel
Policy.
(CHECK HERE)
STUDENT INSURANCE COVERAGE
Beginning fall semester 2012, all students who are 1)
admitted to a degree program, and 2) registered for six
or more credits per semester (or three or more credits
during summer term) that count towards the automatic
assessment of the Student Services Fee, are required by
the University of Minnesota to have health plan
coverage. Students who meet both of these criteria are
automatically enrolled in the University-sponsored
Student Health Benefit Plan.
Note that UNITE courses are EXCLUDED from the
automatic assessment of the Student Services Fee (see
criterion number 2, above). However, if you combining
UNITE courses with on-campus sections, you may
automatically be enrolled into the Student Health
Benefit Plan.
All Student Services Fee-paying University
students will be automatically enrolled in the
University-sponsored Student Health Benefit Plan and
billed a non refundable semester coverage fee. To avoid
being charged, students who have active health plan
coverage that meets certain existing coverage
requirements may request to waive the
University-sponsored Student Health Benefit Plan
(http://shb.umn.edu/students-and-scholars/shbp-waiver).
* By checking this box, I
understand the University-sponsored Student Health
Benefit Plan.
(CHECK HERE)
Press the button
below to submit this course request. Upon successful
submission, in the browser window that follows this
window, you will see a message informing you that your
request has been sent and you may close the browser
window. If the message in the next indicates
otherwise, please follow the instructions provided.
Questions?
Phone: 612-624-2332
Email: unite@umn.edu
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