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Rochester Institute of Technology REGISTRATION FORM

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Rochester Institute of Technology REGISTRATION FORM Rochester Institute of Technology RIT will admit and hire women, veterans, persons with disabilities, and individuals of any race, creed, religion, color, REGISTRATION FORM national or ethnic origin, sexual orientation, age, or marital status, in compliance with all appropriate legislation. Please refer to the Schedule of Courses for registration and payment procedures. Date Quarter: Fall Spring Winter Summer Name of Student (Last, First, Middle) Social Security Number NEW STUDENTS - Please complete the following personal data section. RETURNING STUDENTS - Please complete only those areas in which a change has occurred. M F Date of Birth (mm/dd/yy) Gender Ethnic Origin - (optional) For Reporting to Federal Government Home Address (RIT mail will be sent to this address): C - White (Non-Hispanic Origin) Number & Street B - Black (Non-Hispanic Origin) City/State/Zip Code O - Asian or Pacific Islander I - Am. Indian or Alaskan Native Province/Postal Code S - Hispanic Telephone Numbers (Appears on Classlists): T - Other Home (please include area code) Daytime Education Level - (required) Country of Origin State of Permanent Residence high school, no diploma high school graduate/GED NYS County of Permanent Residence some college, no bachelor's degree Email Address bachelor's degree Used only for correspondence regarding this registration Are you currently enrolled in a degree/certificate program at RIT? Yes No If no, are you interested in pursuing a degree/certificate? Yes No If yes, please list any areas you are interested in: EMPLOYER INFORMATION To have grades and tuition information released to your employer, sign the authorization below and complete the employer information. This must be completed EACH QUARTER. If your employer is NOT listed, we cannot mail your grade information. You must request a transcript to be sent to your employer. Name of Employer Employer Code Student Signature COURSE REQUEST: Some courses may require departmental approval and/or advising prior to registration. PREFERRED CHOICE ALTERNATE CHOICE COURSE NUMBER SECTION CREDIT HRS. TITLE COURSE NUMBER SECTION CREDIT HRS. TITLE Mail to: Registrar's Office Use Only Rochester Institute of Technology Registrar's Office Date Received: ______________ George Eastman Bldg. Date Processed: ______________ 27 Lomb Memorial Drive Processed By: ______________ Rochester, NY 14623-5603 or Fax to 585-475-7005 Rev. 07/05 EMPLOYER MAILING LIST (For Grades To Be Sent To Your Employer) Name of Employer Code* Name of Employer Code* *To be used for employer information (code) on the Registration Form *To be used for employer information (code) on the Registration Form ACU-RITE, Inc. ................................................................. ACURIT Lexington Machinery ........................................................ LEXMAC Addison Precision Mfg. Corp. .......................................... ADPREC Liberty Precision Industries ................................................ LITOOL ADT Security Services ............................................................ ADT Lightnin ............................................................................. LIGHTN Alliance Precision Plastics Corp. ..................................... ALPREC Lockheed Martin Control Systems ................................... LOCKHE AMAREL .......................................................................... AMAREL Manning and Napier ........................................................ MANNAP Bausch & Lomb Micro Instrument Corp........................................................ MICROI Corporate Division ............................................. BLCORP Mobil Chemical-Films Div. ................................................. MOBFIL Eyewear Division ............................................... BLEYEW Monroe Community College .................................................. MCC Vision & Health Care ...........................................BLV&HC Nalge Co./Div. of Sybron Corp .......................................... NALGE Branson-Rochester ........................................................... BRPLJO Nationwide Insurance Enterprise ...................................... NATION Buckbee-Mears Cortland ................................................. BUCKBE NexPress Solutions, LLC ................................................. NEXPRE Builders Exchange ............................................................. BUILEX NORTEL........................................................................... NORTEL Cambridge Industries ....................................................... CAMIND Optical Gaging Products ................................................. OPTGAG CEN Electronics ...................................................................... CEN Ortho-Clinical Diagnostics, Inc. Chase Manhattan Bank N.A. ............................................. CHASE A Johnson & Johnson Company ............................................ OCDI Choice One Communications ............................................ CHONE PAXAR Corporation ............................................................ PAXAR Churchville-Chili School District ...................................... CCSCHO Peko Precision Products ....................................................... PEKO CNG Transmission ............................................................. CNGTR Penn Traffic ........................................................................... PENN Compaq Computer Corp. ................................................ COMPAQ Pennant Foods ................................................................. VANDEN Comstock Michigan Fruit ................................................ COMSTO Pfaudler Inc ....................................................................... PFAUDL County of Genesee .......................................................... GENCTY Philips Broadband and Networks ........................................ PHILIP CVC, Inc .......................................................................... CVCPRO Prolific Technology, Inc. ..................................................... PROLIF Dresser-Rand Co. ........................................................... DRRAND Qualitrol Corporation .......................................................... QUALIT Eastman Kodak Company ................................................ KODAK Roberts Wesleyan College.............................................. ROBWES Foster Wheeler Energy Corp. .......................................... FOSTER Rochester Community Savings Bank ............................ ROCOMM Frontier Corp/Rochester Telephone ................................. ROCTEL Rochester Gas and Electric ................................................. RG&E Garlock, Inc. .................................................................... GARLOC Rochester Instrument Systems ........................................ ROCHIN Genesee Hospital ........................................................... GENHOS Rockwell Telecommunications ......................................... ROCKTE Getinge/Castle .................................................................. CASTLE Schlegel Systems, Inc ...................................................... SCHLEG Gleason Works................................................................. GLEASO Sentry Group .................................................................... SENTRY Gradient Lens Corporation ............................................... GRALEN Silberline Mfg. Co., Inc. ...................................................... SILBER Greece Central School District ........................................ GRESCH Softech Multimedia, Inc. ................................................... SOFTEC Hardinge, Inc. .................................................................... HARDIN Southco, Inc. ................................................................... SOUTHC Heidelberg USA ................................................................. HEIDEL Stone Construction Equip., Inc .......................................... STONE Hickey Freeman Company ............................................... HICKEY Techneglas ....................................................................... TEGLAS Hodgson Process Chemicals, Inc. .................................. HODGSO Ten Cate Enbi, Inc. ............................................................ TCENBI Hover-Davis, Inc............................................................... HOVDAV Torpedo Specialty Wire, Inc ............................................. TORSPE IBS International ....................................................................... IBS TRW ........................................................................................TRW Industry & Energy Assoc. LLC .......................................... IN&ENE Ultrafab, Inc ....................................................................... ULTRAF Industrial Indexing Systems, Inc. ........................................ IINDEX University of Rochester ........................................................ UOFR ITT Automotive ................................................................... ITAUTO U.S. Air Force .................................................................... AIRFOR ITT Industrial Pump Group .................................................. ITTIND Valeo Engine Cooling .......................................................... VALEO ITT Industrial Pump - WTD Division .................................
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