*I will be enrolling as a...

*I will be enrolling as a...


*Regis ID (Located on the side of your Enrollment Agreement Card)
 
*Gender

*First Name
Middle Name/Initial
*Last Name
 
*Number and Street
Street Address Continued
*City or Town
*State or Province
*ZIP or Postal Code
Country
 
*E-mail Address
Parent Email Address
*Phone Number
 
 
You will see steps for how to submit your enrollment deposit online
after you submit your form.
I understand that this fee is non-refundable after
May 1 (January 1 for Spring 2014 students) and will be applied to my first year's charges.
*Signature
*Date
  
 
 
 
1.866.438.7844
781.768.7100
admission@regiscollege.edu
www.regiscollege.edu