CPM Course Application : Extension Studies : Texas State University

Are you a Texas State student? *

Yes

No

If yes, what is your Texas State ID number?

Last Name *

First Name *

Middle Initial

Previous / Other Names

Current Address or P.O. Box *

City, State, Zip *

Business Phone #

Home Phone #

Cell Phone #

Primary Email address *

Secondary Email Address

Permanent Address if different from above

Date of Birth

ARE YOU REGISTERING FOR CPM TRACK(S), COURSES(S) AND LOCATION (ROUND ROCK OR SAN MARCOS)? List tracks, course numbers and location. *

ARE YOU TAKING COURSE FOR UNDERGRADUATE OR GRADUATE CREDIT? *

If you are a student at another university, which university?

Are you currently on suspension from any college or university? *
Yes
No

EXTENSION CREDIT COURSE POLICIES
PLEASE READ THE FOLLOWING TEXAS STATE UNIVERSITY POLICIES AND PROCEDURES RELATED TO EXTENSION STUDIES. BY REGISTERING FOR THE CPM COURSES YOU ARE ACKNOWLEDGING THAT YOU HAVE READ AND REVIEWED THE POLICIES SHOWN BELOW.

Residency Status
Students registering for extension courses, as determined by the university, will automatically be considered as “non-resident" status. Being in "non-resident" status will not affect the fees charged for your extension course(s). If an applicant or student is classified as a non-resident and wishes to be reclassified as a resident, then the srudent should complete the residency paperwork available at the Office of Undergraduate Admissions.

Texas Success Initiative (TSIP)
All Texas residents taking courses for credit (including extension courses) must be compliant with Texas Success Initiative requirements. Please answer the following questions.

Are you exempt from the required assessment? *
Yes
No

Have you taken the required assessment? *
Yes
No

Attach evidence of Texas Success Initiative compliance if you are a Texas resident, but not a Texas State student.

If you are not a Texas State student, but are a Texas resident, you must provide evidence of Texas Success Initiative compliance along with this application. Evidence includes an unofficial transcript of college courses earned or a college diploma (which can be scanned and attached to this application).

Additional evidence of TSIP compliance includes qualifying SAT/ACT, TAKS, THEA or approved alternative test scores. Students from private institutions must provide a copy of their latest semester transcript or grade report, or a letter of good standing from their university. If you are unsure about your TSIP status and requirements, contact the University's TSIP Program Office at 512-245-3942.

Waivers, Exemptions and Third-Party Billing
If you will not be paying for your extension course(s) because of third-party billing such as your employer, Chapter 33, or the Hazlewood Exemption, or if you will be using your Texas Tomorrow Fund or any kind of tuition waiver, please attach documentation.

Attach or mail third-party billing information (if applicable).

If you are planning to use a 3rd party billing for CPM courses, plesae contact Ms. Marilyn Balanoff, Office of Distance & Extended Learning at mb39@txstate.edu or 512-422-8955.

Meningitis Vaccination
As of January 1, 2012, Texas law requires all new college students under 30 years of age to be inmmunized against bacterial meningitis before they enroll in an institution of higher education. State law mandates that first-time college students, students transferring from another institution, and students who are re-enrolling following a break of at least one fall or spring semester be inoculated against the illness. A hold is automatically applied to all students' records, and the hold remains for students who do not satisfy the requirements of this regulation. If you have this hold on your record, you will be unable to register for classes without first providing proof of vaccination, exemption, or a waiver.

Are you exempt from the vaccination because of your age or previous enrollment status?
Yes
No

Have you received the required meningitis vaccination? *
Yes
No

If you answered yes, but have not provided documentation online through Magnus, you can do so at http://www.healthcenter.txstate.edu/meningitis/submitproof.html. Once you provide documentation, your hold will be lifted.

If you are enrolling only in an online extension course or program with no face-to-face component, you are exempt from the required vaccination, but will need to complete a waiver, available through the Office of Distance and Extended Learning.

Your hold will be automatically lifted if you qualify for these exemptions.

Prerequisites
If your course requires a prerequisite, you will be required to submit an official transcript. Official transcripts should be mailed to the Office of Distance & Extended Learning, 601 University Drive, San Marcos, TX 78666. Texas State academic departments will determine if the course satisfies the prerequisite requirement.

Holds
If you have a hold on your account, it will prevent you from being able to register.

You can check for holds on the Admissions web site.

Family Educational Rights and Privacy Act (FERPA)
FERPA protects the privacy of the student education records and guarantees students' access to their own records. In order for the Office of Distance and Extended Learning to release or discuss a student's academic record with a specified third party a Grant Access Student's Record Form must be on file with the University. Go to http://www.registrar.txstate.edu/persistent-links/ferpa.html to print the form. Complete the form and upload.

Attach Grant Access Student's Record Form here

Academic Honesty *
By checking here I certify I understand the university expects students to be honest in all academic work. I commit to academic honesty. I agree to follow the policies and procedures of the Office of Distance and Extended Learning as outlined on the Distance and Extended Learning Web site.

Disability Notification
Please note that additional information about accommodations for disabilities is available at the Office of Disability Services, Room 5-5.1 LBJ Student Center, or 512.245.3451 (Voice TTY).

Do you have a disability which may require special accommodations? What is the nature of your disability?

Extension Credit Courses Policies
Extension credit courses are administered through the Office of Distance and Extended Learning.

The following important policies govern extension credit courses. Failure to follow the policies and procedures for dropping an extension course may result in a reduction of your GPA due to an "F" being assigned.

1. Drop Refund - Refunds for a dropped extension course are given according to university policy for regular university courses on campus. Refer to the web page, Dropping an Extension Course, on the Extension Studies Web site for more information.

2. Enrollment in an extension course does not constitute official admission into the university, and non-Texas State students may take extension courses.

3. Students on active suspension from Texas State are ineligible for extension credit.

4. Full-time students at Texas State who will have a course overload if they take extension courses must seek the permission of an approved advisor from the appropriate college within the university.

5. Students from other institutions who wish to transfer extension credit should obtain the approval of their home institution prior to enrolling.

6. Students may enroll in an extension course for Audit only with prior approval from the instructor and if space is available. Payment is required in full for Audit only enrollments.

7. Transcript records are maintained for all credit earned by extension.

8. A maximum of 30 semester hours for Texas State credit may be completed through a combination of correspondence and extension courses.

9. Once a registration form has been submitted, no changes can be made to the college credit request.

10. The completion of this application does not guarantee enrollment in the class. The following are required for official enrollment:

One completed Extension Course Application per course

Completed tuition waiver/exemption request forms must be received by the Office of Distance and Extended Learning no later than the twelfth class day for fall and spring semesters, and the fourth class day for summer semesters (if applicable).

Verificatin of TSIP compliance (if applicable)

Proof of meningitis vaccination or exemption (if applicable)

11. Enrollment in an extension course will be accepted up to and including the final day for schedule changes as listed in the Schedule of Classes. Check the Schedule of Classes for this date.

12. Students are responsible for ascertaining whether or not (a) credit for an extension course will apply to a particular program, and (b) credit for an extension course will transfer to another educational institution.

By checking this box, I acknowledge I have read and understand the above "Extension Course Policies" governing extension credit and I agree to accept them.

Please feel free to add any additional information which may affect your application.

Division of Academic Affairs

Extension Studies

Enroll in a Course

CPM Course Application

EXTENSION CREDIT COURSE POLICIES

Residency Status

Texas Success Initiative (TSIP)

Waivers, Exemptions and Third-Party Billing

Meningitis Vaccination

Prerequisites

Holds

Family Educational Rights and Privacy Act (FERPA)

Disability Notification

Extension Credit Courses Policies