Enrollment Agreement Correction Request Form

Enrollment Agreement Correction Request Form
Current Campus*
Admissions
Printed Name:*

First NameMiddle NameLast Name
Student ID*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
IMPORTANT NOTE: Students receiving Title IV funds should consult the Financial Aid Office to discuss the impact of all changes on financial aid eligibility, both now and in the future. Changes will be subject to the program availability, course availability and catalog (volume and number) in place at the time of the change.
****Select (X) the option(s) that apply and fill out the section with the required information****
CORRECTION TO SELECTED PROGRAM OF STUDY
Change Program from*
to*
CORRECT DISABILITY SERVICE REQUEST
In accordance with the Americans with Disability act (ADA), will you require any reasonable accommodations from University of the Potomac?
Previous answer:*
Correct answer: *
CHANGE OF PREFERRED CAMPUS
Change my preferred campus to:*
By checking the boxes below:*

I am requesting the changes above and understand that changes are subject to all regulations and obligations as detailed in the University of the Potomac Catalog and the Enrollment Agreement.I understand I am responsible for all financial obligations as detailed in the University Catalog.
Changes may take effect in the following term
Student Signature*

Clear
Date:*

MonthDayYear
Office Use Only

Printed Name/Signature

Admissions: _______________________________ [ ] Approved [ ] Denied

Comments: _____________________________________________________
Should be Empty:

Enrollment Agreement Correction Request Form

Changes may take effect in the following term