NON-MATRICULATE APPLICATION

YOUR INFORMATION

First Name

Last Name

Preferred Phone

Mobile Phone

Work Phone

Home Phone

Other Phone

Email

Birthdate

Social Security Number

Gender

MaleFemale

DEMOGRAPHIC INFORMATION

Are you Hispanic or Latino?

Hispanic or LatinoNot Hispanic or Latino

Select one or more of the following races:

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite

ADDRESS INFORMATION

Street Address

City

Country

State

State/Province

Postal Code

ADDITIONAL INFORMATION

Are you a Westmont employee?

YesNo

Have you ever attended Westmont?

YesNo

Westmont Email

Dates Attended

Are you a student at Providence High School?

YesNo

Courses will be taken for:

CreditAudit

TERM/COURSE SELECTION

Here are the fees for Mayterm/Summer term classes and Regular term classes.

Term:

Term ID

Course Name

Course Offering SF ID

Course Number

Instructor

Location

Meeting Times

Course ID

I agree to pay the tuition and/or fees associated with this course

If admitted to Westmont College as a non-matriculated (special) student, I agree to abide by the college regulations and to support the values of the college as stated in the Community Life Statement.

HIDDEN FIELDS

FORM ID

Contact Id

Form Name