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Cornell University School of Continuing Education and Summer Sessions
MAKE-UP INCOMPLETE REGISTRATION

Student Information

First name: 
Last name: 
Middle initial: 
U.S. Social Security #: 
Date of birth: 
Cornell ID: 
NetID: 
Address: 
City: 
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Telephone #: 
Cornell Employee?:[ ] Yes     [ ] No

Emergency Contact Information

Name: 
Address: 
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Telephone #: 

Department and course numberCourse TitleInstructor's SignatureFee*
    
    
    
Total fee: 

* Course fee: $50 per course. An additional fee of $7.50 per week is charged if you're enrolled only to make up an incomplete.

By my signature I recognize my responsibility to read, understand, and abide by the rules and procedures printed in the Summer Session catalog. I further recognize that I will not be exempted from the rules and procedures because of ignorance, negligence, illness, other personal factors, or contradictory advice from any source.

Signature:  Date: 

Cornell University School of Continuing Education and Summer Sessions; B20 Day Hall; Ithaca, NY 14853-2801 Telephone: 607.255.4987