Application Form for Individual (Open Entry) Courses

Instructions for completing this form:

1. Complete Section A

If you do not have a UNB student number, leave the space blank.

Students in Degree Programs are advised to discuss their course selections with the appropriate academic Department or Faculty before applying.

2. Complete Section B

Choose the appropriate course

Audit requires the permission of the Instructor.

Before they can register in an Online@UNB course, full-time students at UNB require the permission of the dean of the faculty offering that course.

3. Payment of Fees Required

Payment can be:

cheque

money order

Mastercard, Visa or American Express (Do not send card information via the Internet)

part-time Canada Student Loan

approved employer Purchase Order

NOTE: Required Fields are marked with an asterisk (*)

Section A

Student Number

*Primary Email Address

UNB Email Address (If you are a current UNB student.)

*First Name

*Middle Name

*Last Name

*Street Address

*City

*Province, Territory or State

*Country

*Postal Code

Address while attending UNB (please choose one): Same Address Different Address

Telephone Numbers

Home Phone Number

Work Phone Number

Mobile Phone Number

General Information

Have you ever been required to withdraw from any post-secondary institution, including UNB: Yes No

Gender: Male Female

*My mother tongue is

*Status in Canada: Canadian Student Visa Permanent Resident Other - please specify:

Permanent Residents must submit a copy of the front and back of their permanent residence card prior to completion of registration. This can be emailed to extend@unb.ca or faxed to 506 453-3572

*Country of Citizenship

*Birthday

New Students

Have you taken any classes with us before, or applied to UNB in the last year: Yes No

Institutions previously attended (including UNB)

Name of school(s)

City or Town

Province

Country

Dates

How many courses do you wish to take

Do you plan to complete a program at UNB, or is this a course for interest

Degree/Certificate Program Information

Program Admittance (Please choose one): I have not been admitted to a Degree/Certificate Program at UNB
Course Information Follows

I have been officially admitted to the Degree/Certificate Program

I was previously registered at UNB in the year

I am a Registered Nurse: Yes No

Are you a Full-time or Part-time Student at UNB: Full-time Part-time

How did you hear about Online@UNB: Brunswickan Ad
Alumni News
Local Newspaper
Web site
Campus Canada
Canadian Virtual University
Campus Connection
Calendar
Faculty Member
Friend
Other, please specify:

Section B

Course Information - Course Designation

Text book cost are in addition to the course fees and the books may be purchased from the UNB Bookstore.

Non-Canadians must add the fee differential for each three credits of the above courses. (All prices are listed in Canadian currency.)

I wish to apply for

Additional Comments

Privacy Policy

The personal information requested on this form is collected in relation to and is needed by the University of New Brunswick for the purposes registration in online courses, and will, upon registration, form part of your student record under the authority of the University of New Brunswick Act.

Your student record may be used and disclosed as provided for in the University Regulations, Section X, Confidentiality, Security, and Release of Academic Records.

If you have questions or concerns regarding privacy or management of personal information at UNB, you can consult www.unb.ca/privacy