Registration Form, ThM Historical Theology- London
Winter 2013 Module
Full Name: _______________________________________________ Student ID:________________________
Full Mailing Address: __________________________________________________________________________
Email:firstname.lastname@example.org Phone (primary contact):_________________________
Section 2 - Student Status (choose only one):
Section 3 - Winter 2013 Module (choose only one):
* I understand that I should complete all required modules within three years of initial matriculation.
**Post-modular coursework deadline is also the deadline to submit an Incomplete Request and/or Course Withdrawal Request. For details and instructions about submitting an Incomplete Request and withdrawing from a course, please see the appropriate Degree Program Section of the catalog.
Section 4 - Expected Graduation Year: I expect to graduate in May 20_____.
Section 5 - Student Privacy Rights:
I have read the Annual Notification of Privacy Rights under FERPA. Yes _____ No _____
I am submitting a Request to Withhold Directory Information. Yes _____ No _____
Student's Signature:__________________________________________ Date:____________________
Westminster Theological Seminary, P.O. Box 27009, Philadelphia, PA 19118, Fax: 215-887-5404, email@example.com