High School Student Non-Degree Enrollment Application

Thank you for your interest in taking coursework with Immaculata University! Please be aware this form is for prospective students who are currently enrolled full-time in a high school program. If you are not currently a high school student, but would like to register for classes as a non-degree seeking student, please use this link to access our Non-Degree Seeking Application.

High School students, to complete your registration, please complete all steps:

1. Fill out the application form in its entirety. Required fields are marked with an asterisk (*). You only have to complete this form once per semester. Please ensure all information is correct and free from errors before submission.

2. Once this application form is submitted, you will be redirected to a course selection page. You must complete a registration form for desired course(s). Course registration pages will have all information surrounding the course, including registration deadlines.

Please note, registrations may not be processed without a complete application submission, registration form(s) and payment(s) for all desired courses. Registrations will not be accepted past published registration deadlines.

Registrations are final after course start date.

Contact our offices here with any questions.

STUDENT INFORMATION

Student Email Address*

Student First Name*

Student Middle Name

Student Last Name*

Student Birthdate*

Student Mailing Address*

Country

Street

City

Region

Postal Code

Student Mobile Phone Number*

Student Social Security Number

Gender

Female

Male

Prefer not to say

Are you Hispanic or Latino?

Yes

Regardless of your answer to the prior question, please indicate how you identify yourself. Choose all that apply.

Have you taken courses at Immaculata before?*

Yes

High School Name*

High School CEEB Code*

High School City*

High School State*

Guidance Counselor/Principal Name*

Please select the term in which you plan to enroll:*

Students requesting to take courses while still in high school must exhibit maturity and demonstrate above average academic achievement to benefit from a college-level class. Eligibility is determined by your High School Counselor/Principal.

I wish to participate in the Immaculata University High School Program, taking college courses authorized through my high school to earn college credit. These credits will become part of my official academic history, and I understand that they must be reported when applying to other academic institutions. Prior to my graduation from high school, I will notify my high school counselor and the University if I intend to continue at Immaculata University to complete my program of study. In addition, I authorize my high school and the University to exchange any necessary information including my academic history, to facilitate awarding of college credit and enrollment at the University.

I authorize the Registrar’s Office of Immaculata University to forward to my high school counselor or principal the final grades for any courses in which I enrolled through the high school program

Please check the box below and type out your full name and today's date in lieu of a signature.

I, the STUDENT listed on this form, confirm all provided information is correct and I agree to the terms above.*

Student Full Name*

Date of Student Signature*

Additional Student Acknowledgement

STUDENT PRIVACY RIGHTS & RESPONSIBILITIES I understand that Immaculata University is bound by the Family Educational Rights and Privacy Act (FERPA) which prohibits Immaculata University from releasing any information from my education record without my written permission. Therefore, I grant permission to Immaculata University to share my educational and financial records with the Parent or Guardian named below. I also grant permission to share my educational records with my named High School.

Please check the box below and type out your full name and today's date in lieu of a signature.

I, the STUDENT listed on this form, confirm all provided information is correct and I agree to the terms above.*

Student Full Name*

Date of Student Signature*

Parent/Guardian Information

Parent/Guardian First Name*

Parent/Guardian Last Name*

Relationship to Student*

Parent/Guardian Email Address*

Parent/Guardian Mobile Phone Number*

Is your address the same as the student's listed above?*

Yes

Parent/Guardian Mailing Address*

Country

Street

City

Region

Postal Code

Parent Acknowledgement

PARENT / GUARDIAN FINANCIAL RESPONSIBILITY
Payment of Fees/Promise to Pay I understand that once I authorize my dependent’s registration for Immaculata University course(s), I am accepting full responsibility to pay all tuition, fees, and other associated costs. I further understand and agree that my authorization for my dependent’s registration and acceptance of these terms constitutes a promissory note agreement in which Immaculata University is providing educational services and I promise to pay for all assessed tuition, fees and other associated costs. Checks are payable to Immaculata University and due at time of registration.

Debt Collection I understand and accept that if I fail to meet my responsibility to pay my dependent’s student account bill and any other monies due and owing to Immaculata University by the assigned due date, and I also fail to make acceptable payment arrangements to bring my account current, Immaculata University may refer my delinquent account to a collection agency. I further understand that if Immaculata University refers my dependent’s student account balance to a third party for collection, a collection fee will be assessed and will be due in full at the time of the referral to the third party. The collection fee will be calculated at the maximum amount permitted by applicable law, but not to exceed 40% of the amount outstanding. Finally, I understand that my delinquent account may be reported by the University or the third party collection agency to one or more of the national credit bureaus. I authorize Immaculata University and its agents and contractors to contact me at my current and any future cellular phone numbers, email addresses, or wireless devices regarding my dependent’s delinquent student account.

Please note, registrations are final after course start date.

Parents/Guardians of students registering for classes must check the box below and complete their full name in lieu of a signature.

I, the PARENT/GUARDIAN of STUDENT listed on this form, confirm all provided information is correct and I agree to the terms above.*

Parent/Guardian Full Name*

Date of Parent/Guardian Signature*