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

Student Information:

 
Last Name First Name MI Home Telephone Number
  Yes     No
U.S. Social Security # Date of Birth Are you a Cornell employee?
 
Permanent Address City State Zip Country (if not U.S.)

Emergency Contact Information:

 
Last Name First Name Telephone Number
 
Address City State Zip Country (if not U.S.)

Course Enrollment:

   
Department and course number Course title Instructor's signature
   
Department and course number Course title Instructor's signature
 
Course charge ($50 per course) Fee* ($7.50 per week) TOTAL CHARGES

*Charged if only enrolling to make-up an incomplete grade

Student's Signature:

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

For Office Use Only
Prepaid:  Paid:  Total:  Check #: 
Date:  Acct. initials:  Reg. initials:  Misc.: