RIT - Academic Support Center | Application & Billing Statement Confirmation

Learning Support Services
> Application and Billing Statement Form

Student Information
Date:	Saturday, 08/30/2008 5:16 AM EST
Status:	New Student Returning Student
Year Level:	*Required
College:	*Required. Please select an item.
Major:	*Required
Name:	*Required
Email:	*Required
University ID:	*Required
Campus or Local Address:
Phone:	RequiredRequired
Parents' Names:	*Required
Home Address:
City:
State:
Zip Code:
Home Phone:	*RequiredInvalid format.
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.