:: Polytechnic Institute OF NYU

ePoly

DO NOT USE THIS FORM if you are a:

(1) CONTINUING NYU-Poly student, who has been admitted to a graduate degree or certificate program AND has been enrolled for at least one semester. You may register online at http://psdata.poly.edu. Online Course sections are designated as INET.

(2) NEW NYU-Poly student, who has been admitted to a graduate degree or certificate program BUT has never enrolled for any semester at Poly. You must contact an academic advisor from your department who will help you register for courses and map out your plan of study.

This form is for students who want to take courses before making a commitment to a degree or certificate program or who wish to take courses for professional development or personal enrichment. As a non-matriculated student, you do not have to go through the graduate admissions process, just complete the form below. After we receive and process your information, you will receive an email with your Student Login and Password.
Welcome to ePoly!

Required

First | Mi

Last

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.)

Employer

Date of Birth

DD/ MM / YR

Gender

Male

Female

Marital Status

Single

Married

Entrance Term:

Fall of

Spring

Summer

How did You hear about eNYU-Poly

Internet Search

Email Advertisement

Brochure / Postcard

Polytechnic Institute of NYU Website

Company is eNYU-Poly Partner

Professional or Trade Organization is eNYU-Poly 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 No

Please list the schools you have attended

School 1
Date	MM / YR
Degree

School 2
Date	MM / YR
Degree

I would like to register for the following course(s) (Maximum of 2)
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 financial responsibility 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 set forth in the current Polytechnic Institute of NYU SCHEDULE OF CLASSES. I understand that enrollment as a special student does not grant or imply admission to a degree program at Polytechnic University.

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