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Express Education Registration Form

Personal Information
First Name		Middle Name
Last Name		E-Mail
Home Address
City	State Zipcode
Home Phone		Cell Phone
Gender		Date of Birth
Place of Birth		SSN
U.S. Citizen?		If no, what country?
Have you attended NNU before?
Ethnicity	Hispanic or Latino Not Hispanic or Latino
Race	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
High School		Expected Graduation Year

Parent/Guardian Information
Last Name		First Name
Address
City	State		Zipcode
Home Phone		Business Phone

Course Registration:
Dept & No.	Course Title	# Credits	Instructor's Name

Payment is due at the time of registration

Payment Calculation

Total # of Credits

$100 per credit

Tuition Due
$

Method of Payment:
Charge Card Type
Charge Card Number
Expiration Date
Confirmation Number
Check -- #	Send to: NNU Express Education Attn: Cindy Roberts 623 Holly St. Nampa, ID 83686
Please send information regarding a payment plan

ADDITIONAL INFORMATION:
This class is to be treated as any university class. If you drop the course, you will need to complete a drop slip (available from the Registrar's Office or Express Education Office in Helstrom Business Center). When you receive your grade it will be an official transcript. Grades will be posted to the permanent transcript at the same time. If you need additional transcripts they may be obtained either by written request from the Registrar's Office. NNU does not charge for transcripts.

STUDENT AGREEMENT:
If selected an as Express Education student, I acknowledge that this status is extended by Northwest Nazarene University based upon recognition of my strong academic performance in high school and that this status is extended at the discretion of the University. I understand that courses taken at NNU do not necessarily count toward high school graduation requirements and it is my responsibility to work with my high school administration to meet requirements for high school graduation. I certify that the statements in this application are true and correct to the best of my knowledge.

Student Online Signature

PARENTAL CONSENT (if under 18):
As the parent/guardian of the student applying for the Express Education Program at Northwest Nazarene University, I agree to the following: 1) support for the student's desire to participate in the program, 2) support the student as needed to perform successfully, 3) acknowledge responsibility for tuition, fees, and other expenses. I also realize that any acceptance of credit for application to the student's high school program, school district graduation requirements, or state graduation requirements is granted solely at the discretion of the student's high school. Acknowledging these and other factors and having met with the student's guidance counselor, I hereby agree and request that my son/daughter be allowed admission into the Express Education Program at NNU.

Parent Online Signature

My parent(s) or guardian(s) may have access to my academic record. Yes No

I certify by initialing the box to the right that the statements in this application are true and correct to the best of my knowledge.