Special Student Registration for Online Courses

Intent to Register Form

An individual requesting permission to register as a non-degree student is assigned a special student status. Included in this status are individuals who want to take courses for professional advancement, personal development, or individuals from other universities wishing to transfer credit back to their university, but who do not want to earn a degree.

A visiting student is allowed to take up to nine credit hours at NYU-Poly without formally applying for admission. If a visiting student desires to continue at NYU-Poly as a matriculated student in a graduate degree or certificate program, they must follow the formal application process.

Individuals who wish to register for an online course must fill the below “Intent to Register Form.” Upon completion of this form, you will need to submit in a copy of your:

Transcripts
Resume
Photo ID

Please send this documentation by e-mail to nyuepoly@poly.edu or fax to 718-260-3571. A representative from the NYU-Poly Online Learning program will contact you with instructions on how to proceed. To speak with a representative of the NYU-Poly Online Learning program, please call 877-50-EPOLY (877-503-7659).

NYU-ePoly Special Student Application Deadlines

Summer 2012: May 25th, 2012
Fall 2012: August 31st, 2012

* Individuals who wish to register for a course on the Brooklyn campus must speak directly to the Office of Graduate Admissions.

* If you are a continuing or new NYU-Poly Online Learning student, please click here for more information on how to register.

*If you wish to register for an undergraduate course, please click here.

First Name: *

Last Name: *

Social Security Number:

Street: *

City: *

Country of Residence: *

State or Province: *

Zip code/ Postal code: *

Country of Citizenship: *

Home Phone (include area code and ext.): *

Business Phone (include area code and ext.) :

Email: *

Employer:

Date of Birth:

Gender: *

Male

Female

Marital Status: *

Single

Married

Entrance Term Year: *

Entrance Term: *

Fall

Spring

Summer

How did You hear about NYU-ePoly :

Internet Search

Email Advertisement

Brochure / Postcard

Polytechnic Institute of NYU Website

Company is NYU-ePoly Partner

Professional or Trade Organization is NYU-ePoly Sponsor

Special Code if applicable::

Have you previously applied to Polytechnic Institute of NYU?:

Yes

Have you previously attended Polytechnic Institute of NYU as a Non-matriculated Student? :

Yes

If Yes:

Number of semesters :

Last Semester attended :

Student ID:

Reason for enrollment: To obtain a degree :

Yes

Please list the schools you have attended

School 1: *

Date:

Degree: *

School 2:

Date:

Degree:

I would like to register for the following course(s):

(Maximum of 2 Courses)

Course 1:

Course / Reference #: *

Course Title: *

Credits / Units:

I have contacted an academic advisor to determine if this course is appropriate for me. :

Yes

Academic Advisor Name:

Course 2:

Course / Reference #:

Course Title:

Credits / Units:

I have contacted an academic advisor to determine if this course is appropriate for me.:

Yes

Academic Advisor Name:

NOTICE OF FINANCIAL RESPONSIBILITIES:

I hereby accept the financial responsibility for payment of all charges in connection with the above registration, as well as responsibility for acquainting myself with the registration, withdrawal and refund policies and procedures currently in effect. I understand that enrollment as a special student does not grant or imply admission to a degree program at NYU:POLY.

By entering my name here, I certify that the above information is true and accept all responsibilities outlined above.

Name: *

NYU-ePoly Online Graduate Program

NYU-ePoly Online Learning

Special Student Registration for Online Courses

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