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? I am currently enrolled or have previously enrolled through UNITE UNITE Web Site Other Web Site (please specify, below) From a University of Minnesota professor, administrator, staff member or student (please tell us who, below) From a colleague, co-worker or employer From a professional organization or at a conference (please tell us more, below) Other Source (please tell us more, below)

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: In a Ph.D program at the University of Minnesota In a Graduate (Master's) degree program at the University of Minnesota In a Certificate program at the University of Minnesota In a Bachelor's degree program at the University of Minnesota Graduate Non-Degree Credit at the University of Minnesota Guest of the University of Minnesota (undergraduate credit) Senior Citizen Education Program (SCEP)

IF admitted to University of Minnesota Graduate or Undergraduate Program, which program/major?

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?

  I will use the proctor on file with UNITE from a past semester I will use a proctor at my employment (i.e., manager, HR person, etc.) to act as proctor I will use a proctor at another institution or public library I will use a testing center I have contacted the instructor(s) and there is no need for a UNITE-approved live, in-person proctor I do not yet have a plan

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)

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)

UNITE courses are currently excluded from the automatic assessment of UMN-TC Student Services fees. However, if you enroll in both a regular on-campus course and a UNITE course during the same semester, you may automatically be enrolled into the Student Health Benefit Plan and billed the associated premium for the entire semester.

To avoid being charged, students who have active health plan coverage that meets UMN-TC requirements may request to waive the Student Health Benefit Plan by completing a SHBP waiver. The waiver must be completed prior to the start of the semester.

* 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.