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University of St. Thomas
3800 Montrose - Houston, Texas  77006-4696
(713) 525-3540

GRADUATE CREDIT REGISTRATION FORM

APPLICANT PROFILE:

This form is a professional document and is considered your registration form. 
Please make sure you answer all the questions carefully.  

* Indicates Required Field

*Last Name    
 		 *Social Security Number   
   
*First Name    
  		 *Date of Birth                  
   (example: 00/00/0000)
*Middle/Maiden Name
   		St. Thomas ID#                
  (Optional-If you know your ID# please enter)
*Address       
  		E-mail                              
 *City/State     
 		 *Home Phone Number   
   
*Zip Code       
  		  Cell Phone Number    
    
 *County          
    		*Gender            *Ethnicity     
*Religion        

Information regarding the applicant's race or ethnicity is entirely voluntary and will be used in a nondiscriminatory manner, consistent with applicable Civil Rights laws.
      

Bachelor's Degree

Graduate Degree
*Name of Institution: 
  		Name of Institution: 
     
*City/State:                  
  		 City/State:                
*Degree:                   
       		Degree:                    
*Month/Year Earned: 
  		 Month/Year Earned:

 (List Only Colleges/Universities in which you have earned a Degree)
                                                         

COURSE REGISTRATION INFORMATION:

Dept:

Course #
  

Section  
    		Course Title      
 
Day
Time
8:30 - 3:30		  Professor
   		 Location  
 


I understand that once I have submitted this registration, I must follow the formal drop procedures of the University to terminate registration for a course according to the current semester's calendar of important dates.  Non-attendance does NOT automatically withdraw me.  Furthermore, I agree to pay all collection expenses, including reasonable attorney fees, which the University may incur if I do not fulfill my payment obligations.  I certify the information contained in this registration form is true and correct.

When you select submit, you will be given a confirmation.  Please keep this document for your records.

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Your confirmation number will be your place number in the class.
 Alternative Teacher Certification Program
Pasadena Independent School District
11111 Beamer, Houston, TX 77089
713/740-0029 |713/740-4007 fax
atcp@pasadenaisd.org
 

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