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Work toward greatness.SCHOOL OF EDUCATION REGISTRATION FORM FOR GRADUATE NON-DEGREE STATUS____ ____ ____-____ ____-____ ____ ____ ____ _________________________________________________________________________ U Number Last Name First Middle Fall _______ Spring _______ Summer I _______ Summer II _______ Year Year Year YearPlease provide information below. (Optional)DATE OF BIRTH ____/____/____ ETHNICITY (OPTIONAL): 1. African-American, non-Hispanic 2. Asian or Pacific Islander 3. Hispanic4. American Indian or Alaskan native 5. Caucasian, non-Hispanic 6. Other _______________________________ (please specify)EMERGENCY NAME: _______________________________________________________ RELATIONSHIP ___________________________ Last FirstEMERGENCY ADDRESS:_______________________________________________________________________________________________ _______________________________________________________________________________________________EMERGENCY TELEPHONE: (_________) __________________________I understand and agree that my admission, if granted, my registration and continuance on the rolls and graduation are subject to all policies, rules, regulations, and procedures set forth in the current bulletins, catalogs, and other publications, and notices of Pace University and as they may be amended, including but not limited with respect to scholarship, discipline, attendance, immunization requirements, and payment or abatement of fees.Signature _____________________________________________________________________ DATE _________/__________/_________ Month Day YearSAMPLE DAY COURSE R=THUR    U=SUN REFERENCE NO. CRS CAMPUS NY/MT/WT/GC/PL/BR/OC SUBJECT COURSESAMPLE CHAIR GAS/GCS SIGNATURE DATE GDN/GED18 2009REG. OPERATOR'S SIGNATURE//DATE (MM/DD/YYYY)FOR OFFICE USE ONLY_____________________________________________________18 2012N Y X Y Z 100AM 99999 3

2012 19FINANCIAL AFFIDAVIT FOR INTERNATIONAL STUDENTSAn international applicant accepted for admission to a graduate program at Pace University who requires a Certificate of Eligibility for a student visa must submit the International Applicant Financial Affidavit below. The completed affidavit must be submitted with a letter from a bank indicating the availability of sufficient funds in U.S. dollars available for one year of study. Applicants are advised to obtain two sets of bank documentation in order to have one set for the embassy use. If any financial support is to be provided by one or more sponsors, the Sponsor(s) Affidavit(s) of Support must also be submitted and the sponsor(s) must provide the required bank documentation. (Note: The Sponsor Affidavit of Support which follows this page may be reproduced.)I certify that I have ___________________ U.S. dollars available to me for the following expenses of my graduate education at Pace University. (insert amount from below) I have indicated the source of my financial support below and have attached original bank documentation in U.S. dollars. The information I have provided on this affidavit is correct and complete. I know that giving false information on this affidavit or in support documentation may result in the cancellation of my admission to Pace University. I also understand that the entire tuition and general institution fee is due at the time of regis­tration for each term, that the insurance cost is an annual fee, and that costs may rise in succeeding terms. I also understand that if I am required to enroll for English language coursework, additional costs will ensue.SCHOOL OF EDUCATION2011-2012 Total Estimated Expenses for the Fall and Spring Terms* Source of Support U.S. Dollars (self or sponsor**)Tuition and Fees (18 credits) $ 14,932.00 __________________Living Expenses (room and board) $ 13,589.00 __________________Health Insurance $ 700.00 __________________Other (books, personal expenses, and transportation) $ 2,780.00 __________________ ____________Total: $ 32,001.00Estimated Expenses for the Optional Summer I and Summer II Terms* Source of Support U.S. Dollars (self or sponsor**)Tuition and Fees (6 credits) $ 4,856.00 __________________Living Expenses (room and board) $ 6,250.00 __________________Other (books, personal expenses, and transportation) $ 651.00 __________________ ____________Total: $ 11,757.00Grand Total: $ 43,758.00__________________________________________ _______/_______/________ ___________________________________________Signature Month Day Year Print Name______________________________________________________________________________________________________________________Print Address______________________________________________________________________________________________________________________Print Telephone Number Fax E-mail*Subject to change **Each sponsor must complete an affidavit of support (see reverse side) and submit official bank documentation verifying availability of funds.Work toward greatness.SCHOOL OF EDUCATIONOffice of Graduate AdmissionOne Pace Plaza New York, NY 10038 USA Phone: (212) 346-1531 Fax: (212) 346-1585 E-mail: gradnyc@pace.eduOne Martine Avenue White Plains, NY 10606 USA Phone: (914) 422-4283 Fax: (914) 422-4287 E-mail: gradwp@pace.edu