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Enrollment Form & Billing Statement

Student Information
Date	Friday, 02/10/2012 6:34 AM EST
Status	New Student Returning Student
Year Level	*Required
Quarter
College	*Required. Please select an item.
Major	*Required
Name	*Required
Gender	Male Female
Email	*Required
University ID	*Required
Campus or Local Address
Phone	*RequiredInvalid Format
Parents' Names	*Required
Home Address
City
State
Zip Code
Home Phone	*Required
Parents' Email
Applying To	Level 1: $440 - Individual appointment/once per week Level 2: $880 - Individual appointment/twice per week Level 3: $950 - Daily appointment/must meet at least 3 times each week
Check any that apply to you	I am registered with the Disabilities Office I am on a RIT tuition waiver I receive funding from a Vocational Rehab or other source

**Structured Monitoring sessions are non-refundable. These sessions are customized and offer the flexibility of entry at any point in the quarter. In the case of an Institute Withdrawal, refund will be made in accordance to Institute policy.**