Non-Degree Application

Name
Contact Information
Permanent Address
Permanent Address
Mailing Address (if different than Permanent Address)
Mailing Address (if different than Permanent Address)
Biographical Information
Birthdate
Birthdate
Permanent Resident
Permanent Resident
Race
Race
Hispanic
Hispanic
Coursework Academic Level
Other Required Information
Have you ever been sanctioned for disciplinary misconduct at any higher education institution for academic or behavioral violations? For the purpose of this question, “sanctioned” includes but is not limited to: dismissal, removal, expulsion, probation, or suspension.
Have you ever been sanctioned for disciplinary misconduct at any higher education institution for academic or behavioral violations? For the purpose of this question, “sanctioned” includes but is not limited to: dismissal, removal, expulsion, probation, or suspension.
Have you ever been charged or convicted of a felony, misdemeanor, or any other crime?
Have you ever been charged or convicted of a felony, misdemeanor, or any other crime?
Signature
Conditions of Non-degree Enrollment
  • Registration as a non-degree student is on a space-available basis and not all courses are open to non-degree student.
  • Non-degree students are responsible for meeting course prerequisites; transcripts may be required as proof.
  • A maximum of twelve credits taken as a non-degree student may be applied towards a degree at the University of Bridgeport.
  • You may register for subsequent semesters as a non-degree student based on your academic performance and good standing in the university.
  • Financial aid is not available to non-degree students.
  • Enrollment as a non-degree student does not guarantee or imply admission to the University.
Signature

My signature below indicates that all the information contained in this enrollment form is complete and correct.  I am aware that any falsification in the completion of this enrollment form, either by error or omission, may result in my being denied enrollment by the University of Bridgeport or may result in disciplinary action.
Signature Date
Signature Date

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1-800-EXCEL-UB (392-3582)

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