Request for Admission and Enrollment in Self-Paced Online (Correspondence) Courses

PERSONAL INFORMATION

Are you a current or recent University of Arkansas - Fayetteville student with access to @uark.edu email?*

Are you a former University of Arkansas - Fayetteville student without access to @uark.edu email?*

First (Given) Name*

Middle Name

Last (Family) Name*

Birthdate*

Are you under the age of 18?

Yes

Gender*

Personal Email Address*

University of Arkansas Student ID

University of Arkansas Student ID*

University of Arkansas Student Information

Enter UARK email address (you@uark.edu)*

Before proceeding, please confirm:
1. I have consulted with an academic advisor regarding my self-paced online course selections.
2. I meet all prerequisites for the self-paced online courses I am requesting.
3. Other than holds for academic standing, there are no holds on my student account that prevent enrollment.

I certify that I have confirmed the above items.*

Select the University of Arkansas college in which you are currently enrolled*

Non UA Student Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Is Permanent Address the same as your Mailing Address

Yes

Permanent Address

Country

Street

City

Region

Postal Code

Text Messaging Option

Do you agree to receive text messages?* (A few each semester to remind you about deadlines)

Yes

Cell phone number with area code at which you agree to receive important text messages and phone calls regarding your course. Please enter numbers only (no dashes). Note: Opting-in for text messages will not remove the need to regularly check your UARK email account.

Cell phone number

I do not agree to receive text messages. The phone number with area code below is for telephone calls only.

Phone Type

Home

Cell

Work

Enrollment Request

Select a country where coursework will be done*

Select a state/US territory where coursework will be done*

Institution at which currently enrolled at a high school or college?*

Institution Name (if enrolled)

Most self-paced online courses are not covered by financial aid or scholarships and do not count toward part-time or full-time enrollment status. Only if the session selected below is labeled with "$$$" may the self-paced courses count toward financial aid and/or scholarship eligibility.

Session in which enrollment is requested*

How did you hear about University of Arkansas Self-Paced Online Courses? (select from list)

Course Selections
Indicate the courses in which you are requesting enrollment. Enrollments are processed on a space-available basis. Submitting a request for a class does not guarantee successful enrollment in the class. Enter course selections below (select from list of courses)

How many courses do you want to take?

COURSE CHOICE 01*

COURSE CHOICE 02*

COURSE CHOICE 03*

COURSE CHOICE 04*

If we cannot accommodate the courses you requested above, you may indicate up to two alternate courses.

First Alternate Course Selection

Second Alternate Course Selection

Student signature*
I certify that all information given on this application is complete and accurate and understand that withholding information requested or giving false information may make me ineligible for admission and/or enrollment. I understand that tuition and fees will be assessed to my University of Arkansas student account and charges are due on the day the course begins. I understand admission to enroll in Self-Paced Online Classes as a non-degree seeking student does not entitle me to enroll in semester-based online or on-campus courses.

Parent Signature (if student is under age 18)

Parent email (if student is under age of 18)*

Undergraduate Admissions

Request for Admission and Enrollment in Self-Paced Online (Correspondence) Courses

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