SVA Continuing Education Registration Form (1)

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Content

fall 2015 registration
[REGISTRATION IS SUBJECT TO ALL TERMS AND CONDITIONS SET FORTH IN THE BULLETIN ]

S ocial Security Number

Birth Date (Month/Day/Year) REQUIRED TO ACCESS GRADES

Last Name

First Name

n I have previously taken a class at SVA

M.I.

n This is a change of address

Street Address

Gender n M

nF

Apt

City

State

Country

|
Home Telephone

Zip/Country Code

|
Alternative Telephone

E-mail

DEMOGRAPHIC INFORMATION

WHERE DID YOU HEAR ABOUT THE SCHOOL OF VISUAL ARTS?

n Hispanic of any race

n Twitter
n Linked In
n Internet Search

n Advertisement
n Friend
n Returning Student
n Walk-in
n Facebook

FOR NON-HISPANICS ONLY:

n American Indian
or Alaska Native

n CE Blog
n Other (please specify)

COURSE NUMBER

TUITION

n
n
n
n

Black or African American
Native Hawaiian or Other Pacific Islander
White
Two or more races

n Asian

FEE

send a bulletin to a friend
If you have a friend who may be interested in taking courses at SVA, please
print their information below and we will gladly send them a bulletin.

Name

Street Address

City

State

Zip

E-mail

office use only
Date/ Time received

Information Verified by

Student ID number

Registered by

Confirmation number

Receipt number

TOTAL PAYMENT

PAYMENT METHOD
n Check Enclosed

n Visa

n Money Order

n MasterCard

Number

n Discover

n Credit Card

n American Express

n JCB

Expires

Advisor signature (Required for all matriculating SVA students)

Card holder signature
[ Signature of parent (if student under 18). I hereby authorize the use of my credit card ]

Authorization code/date

Print Name

register online at sva.edu /ce

FA use only

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