Jenzabar University

First Name:

Last Name:

Daytime Phone:

Email:

UI&U Issued ID

Gender

Social Security Number

Date of Birth

Mailing Address

Mailing Address 2

Mailing City

Mailing State

Mailing Zip Code

Mailing Country

Have you been accepted or previously/or currently attending a UI&U degree program? 

Sponsoring Organization Offering the Class

Location

Course Title

UI&U Issued Course Number

# Credit Hours

Undergraduate or Graduate Credit Hours

License # (for Professional CE credits)

Start Date

End Date

Is payment required with this form? 

Cost of Course

Cardholder Name

Cardholder Billing Address

Transfer of Credit – As with most other colleges and universities in the United States, credits earned are transferable only at the discretion of the receiving school.  

Cancellation/Drop Policy: In order for us to provide the most experienced instructors and superior learning environment, we must ask that you adhere to our cancellation policy.   All tuition and fees are payable before your course begins, and no refunds are available AFTER the course begins.  If you are unable to participate in a course and you cancel your enrollment BEFORE the course begins, the tuition will be refunded. We reserve the right to reschedule a class should circumstances make it necessary.  In this unlikely event, full payment may be applied to the next regularly scheduled course offering.

I understand that successful completion of this course does not guarantee acceptance by credentialing organizations and/or licensing boards.  I also understand that it is my responsibility alone to ensure that this course meets my professional and/or personal objectives. 

I have read and acknowledge the above Transfer of Credit and Cancellation Policy: Type your name in the box below

Date signed