SAMPLE SCHEDULE 
REGISTRATION FORM 
http:// www.uvi.edu  
 
 
 
1. The registration form must be COMPLETED PRIOR to entering the registration area, as it will be used to key your 
course request(s). New students must complete page two.  
 
2. Please make sure the COURSE REFERENCE NUMBER (CRN #) has been entered correctly. Schedules must have a 
CRN# to be entered. 
 
3. Changes in biographical data (name, address, telephone number) must be reported to the Registrar’s Office. 
 
□ Fall   □ Spring   □ Summer I   □ Summer II    Year: ___ Date: _________  Student ID#__________________ 
 
       Level: □ Undergraduate   □ Graduate
 
Name:   
 
Last                                         First 
                             M.I. 
Tel: (Cell) 
(Home)  
 
 
(Work)  
 
Mailing Address:  ______________________________________________________ 
 
 
 
Email: 
Emergency Contact:    
_____________________ 
Last Name 
First Name 
 
                                                           Tel: (Cell)________________(Home) _________________ (Work) ____________________ 
 
 
  CRN# 
SUBJ 
 CRSE# 
SEC   CRED      DAY               TIME 
     AUDIT(Y/N) 
 
 
    OFFICE USE 
CRN# 
SUBJ 
CRSE# 
SEC    CRED     DAY 
TIME        AUDIT: (Y/N) 
 
 
 
 
 
 
 
 
 
  
 
 
Alternate Course Selection(s) 
12345 
MAT 
231 
A 
4 
MTWF 
1:00-1:50 
N 
                                                                                        Total Credits:___________ 
 
____________________________________                                _____________________________________ 
Advisor’s Signature                                                                         Student’s Signature  
 
Office Use: 
 
                                    PIP-Prerequisite in progress            PNM-Prerequisite not met         CTC-Course time conflict 
                                    CLS-Closed class                              CRN-Wrong CRN                        WTL-Waitlisted   
                                    CC-Cancelled class 
 
 
 
 
 
 
 
REGISTRATION FORM
 
http:// www.uvi.edu  
                                                        
  Social Security Number #__________________   □ Fall   □ Spring   □ Summer I  □ Summer II    20 ___
 
Campus:  □STT   □STX 
Level: □Undergraduate 
□Graduate 
 
Name:    
 
_ 
 
 
 
Last 
First 
Middle 
           Maiden 
 
 
Physical Address: 
Local Mailing Address: 
 
  
 
 
  
Zip   
 
  
Zip  
 
 
Phone: Home ( 
_) 
-  
 
Work: ( 
) 
- 
Ext.   
 
 
Sex: □Male   □Female 
U.S. Citizen □Yes   □No 
 
 
Date of Birth:   
 
Permanent Resident   
 
Alien Registration # 
Non Resident Alien: Type of Visa   □F   □J  □H 
 
In compliance with federal reporting requirements, UVI must seek to identify the ethnic background of 
students enrolled.  You are encouraged to supply this information. 
 
□ Black/Non-Hispanic 
□ Asian/Pacific Islander 
□ White/Non-Hispanic 
□ American Indian/Alaskan 
□ Hispanic 
□ Other 
 
   Have you lived in the Virgin Islands for the past twelve (12) months? 
□ Yes □ No 
 
In what state/country is your permanent residence? _  
_____ 
 
 
Year of last attendance at UVI   
__________________________________________________ 
 
 
I certify that the information given on this form is complete and correct. I acknowledge that deliberate 
omissions or falsifications may subject me to immediate dismissal from the University. 
 
Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, you have the 
right to withhold the disclosure of any directory information.  
If you would like that your name not be listed in a directory please indicate:  □ Yes  □ No 
 
 
  
 
Student’s Signature 
 Date 
 
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