University of Southern Indiana

Please DO NOT use this form to register for College Achievement Program (CAP) classes.
Click here for CAP registration ONLY.


NONCREDIT COURSE REGISTRATION OPTIONS:

To mail registration forms: COMPLETE this form, PRINT, RESET, and MAIL form to:

OUTREACH AND ENGAGEMENT
UNIVERSITY OF SOUTHERN INDIANA
8600 UNIVERSITY BOULEVARD
EVANSVILLE, INDIANA 47712

Checks should be made payable to USI.

For telephone registration using Visa, MasterCard, American Express or Discover cards: CALL 812-464-1989 or 800-467-8600.

To FAX registration forms: COMPLETE and PRINT this form and FAX it to 812-465-7061.

For online registrations: COMPLETE this form and click SUBMIT. You will receive confirmation after enrollment in the course is verified.


PERSONAL INFORMATION
* Full Name:

First Name

MI

Last Name
* Street Address:

* City, State, Zip:


City

State

Zip Code

* Home Phone Number:

Ex. 8124651080

Work Phone Number:

Ex. 8124651080

Fax Number:

Ex. 8124651080

*Email Address:

 

If registering for a teacher workshop/event, please include the name of your school, what grade and subject(s) you teach in the Organization Name field.  

Organization Name:

Street Address:

City, State, Zip:


City

State

Zip Code

COURSE/CONFERENCE INFORMATION

COURSE NUMBER COURSE/CONFERENCE TITLE FEE
 Example:  FIT700  Trail Hiking 30.00


CHILDREN'S PROGRAMS ONLY
Date of Birth: Ex. mm/dd/yyyy
Grade in Fall 2014:


PAYMENT OPTIONS

PLEASE NOTE THAT THIS IS A SECURE FORM.  TO TAKE ADVANTAGE OF THIS SERVICE, YOUR INTERNET BROWSER MUST SUPPORT SECURE FORMS.

* Payment Method:
* Name on Credit Card:

* Billing Zip Code:

* Credit Card Number: Ex. 0000111122223333
* Expiration Date: Ex. mmyy (do not include "/")
* CVV Number: How to find your CVV number
Total Fee: $
Please use the area below to explain any information you would like us to be aware of concerning your payment or special requirements you may have.


REFUND POLICIES
Course Cancellation-
Noncredit courses are offered on a cost-recovery basis.  Normally, courses which have not reached their minimum enrollment by one week before the starting date will be canceled and full refunds issued to registrants.

Course Withdrawal-
Courses which meet for three or more sessions:  When you notify us of withdrawal before the second class session you will be charged a processing fee of 15% of the fee paid, not to exceed $15, plus the cost of any materials received.
Courses meeting one or two times:  If you notify us of withdrawal by close of business on the day prior to the program you will be charged a processing fee of 15% of the fee paid, not to exceed $15.  No refunds can be made after the course begins.  Substitutions are usually permitted--call 812-464-1989 to arrange a substitution.
Travel/Study programs, conferences, off-campus workshops, etc. have specific refund policies based upon each program's unique nature.  Call 812-464-1989 to inquire about specific programs.

Refunds for check payments are made by check; refunds for credit card payments are credited to your account.


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8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600

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