Online Studies Registration Form

*(Required Fields)

Personal Information

First Name*:

Middle Initial:

Last Name*:

Maiden Name:

Gender:

Date of Birth*:

Social Security #:

Address 1:

Address 2:

City:

State:

Zip (Or enter "International" for International students):

Telephone Number:

Fax Number:

Email:

Supplementary Information

Status:

War College Student/Graduate:

Veteran Benefits:

Do you expect to receive Financial Aid?

If yes, what type?

Have you taken online courses at Salve before?

How many?

Select one of the following, for the US Government:

Courses

Please complete all fields for each course you wish to register.

Course Code

Section Number

Start Date

Location

Course Title

Books

You may purchase your books directly from the bookstore at the Salve Bookstore Online. When ordering your books on-line, remember that GES courses are listed as section 90.

Payment Information

Payment options require Visa/Mastercard information below.

Full payment of tuition and fees.
Third Party Tuition Reimbursement, such as payment by employers. Fax immediately the third party documentation to the Registrar at (401) 341-2996. (We will charge your card the portion not covered by your employer plus the $40.00 registration fee.)
Military Tuition Assistance Fax immediately the T.A. documentation to the Registrar at (401) 341-2926. (We will charge your card the portion not covered by T.A. plus the $40.00 registration fee.)
Financial Aid (Loans) The option requires no immediate charge to your Visa/MasterCard information below.

Select Your Payment Option:

Credit Card Type:

Credit Card Number:

Security/Validation Code:
(3-digit code located on the back of your credit card.)

Expiration Date:

Comments? Please provide any additional information:

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100 Ochre Point Avenue | Newport, RI 02840-4192 | Phone: (401) 847-6650