Listener Form - Office of the Registrar - McMaster University

OFFICE OF THE REGISTRARGilmour Hall, Room 108Hamilton, Ontario L8S 4L8Fax: 905.527.1105UNDERGRADUATE COURSE REGISTRATIONLISTENER OR AUDITOR□ LISTENER – NOT CURRENTLY REGISTERED IN A DEGREE PROGRAM AND TAKING A COURSE FOR NON CREDIT.□ AUDITOR – CURRENTLY REGISTERED IN A DEGREE PROGRAM AND TAKING A COURSE FOR NON CREDIT.PLEASE COMPLETE A SEPARATE FORM FOR EACH COURSE YOU WISH TO REGISTER FOR.PLEASE FOLLOW THE INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM TO ENSURE YOU HAVE COMPLETED ALLREQUIREMENTS BEFORE SUBMITTING THE FORM TO THE OFFICE OF THE REGISTRAR, GILMOUR HALL ROOM 108.PLEASE PRINTSTUDENT INFORMATIONMcMaster Student Number (if previously registered at McMaster)Date of Birth (YYYY/MM/DD)Student Surname, Given NamesGenderCitizenshipStreet AddressCity, Province, Postal CodeTelephone NumberSession(e.g. F/W/)Year(e.g.2008/09)Course NameCourse Code(e.g. 1A06)Term(e.g. 1,2,3)Day/Evening(e.g. D,E)Lecture Section(e.g. C01)I certify that all of the above statements are correct and complete and that any misrepresentation of these data may result in the cancellation ofmy admission and/or registration status.Student’s SignatureDateI agree that this course is acceptable for a student to participate in as a Listener and that based on the information provided by the student,he/she meets the course requirements to register in the course.Instructor’s Signature or Associate Deans OfficeDateThe information gathered on this form is collected under the authority of the McMaster University Act, 1976. The information is used for the academic,administrative, financial and statistical purposes of the University including, but not limited to, admissions; registration and maintaining records; awards andscholarships; convocation; provision of student services, including access to information systems; alumni; and disclosure to or on behalf of the applicableMcMaster student government. This information is protected and is being collected under section 39(2) and section 42 of the Freedom of Information andProtection of Privacy Act of Ontario (RSO 1990). Questions regarding the collection or use of this personal information should be directed to the, UniversityRegistrar, University Hall, Room 209, Mc Master University.

STUDENTS WILL BE ISSUED A REGISTRATION CONFIRMATION IN THE MAIL FROM THE OFFICE OF THE REGISTRARONCE THE COURSE REGISTRATION HAS BEEN APPROVED AND THE STUDENT IS FULLY REGISTERED.Additional Information for LISTENER Applicants:Applicants who are applying for registration in an Undergraduate course as a Listener must:‣ Ensure they meet the course requirements as outlined in the Undergraduate Calendar.‣ Obtain the instructor’s signature verifying that the course being applied for is acceptable forregistration as a Listener; and based on the information provided to the instructor by the student,the student meets the course requirements.‣ If you are not 65 years of age, credit card information is required for payment of course.‣ Complete the form in its entirety.CREDIT CARD PAYMENT INFORMATIONName as it appears on credit cardCredit Card (select one)VisaMasterCardCredit Card NumberCredit Card Expiry DateSignature of the CardholderDateAdditional Information for AUDITOR Applicants:Applicants who are applying for registration in an Undergraduate course as a Auditor must:‣ Ensure they meet the course requirements as outlined in the Undergraduate Calendar.‣ Have approval of the Chair of the Department and the Office of the Associate Dean.‣ Complete the form in its entirety.Return Completed Application:Office of the RegistrarRoom 108, Gilmour HallMcMaster UniversityHamilton, ON L8S 4L8Fax: 905.527.1105Office Use OnlyPayment Amount: ______________________________________Transaction #.: ______________________________________Transaction Date: _______________________________________Office of the Registrar: September 2010