Single Course Application

Most Recent Institution

Dates Attended

Major/Field

Degree(s) Received

GPA

Would you like to add another institution?

Yes

Additional Institution

Dates Attended

Major/Field

Degree(s) Received

GPA

Would you like to add another institution?

Yes

Additional Institution

Dates Attended

Major/Field

Degree(s) Received

GPA

Please upload unofficial copies of transcripts from all institutions attended.

Part 4. Signature and Payment

Rensselaer Polytechnic Institute
Financial Responsibility Agreement

I understand that by registering for classes I am entering into a financial arrangement with Rensselaer Polytechnic Institute (Rensselaer) and I accept responsibility for all charges billed to my Rensselaer account regardless of (i) whether or not I am listed as a dependent on my parents or anyone else’s tax return, or (ii) any expected payments from any third-party resource – including, but not limited to, financial aid, employer reimbursement, scholarship, or any other external resource. I am and remain personally responsible for paying any and all balances due to Rensselaer Polytechnic Institute.
I understand that if I'm not planning to attend, it is my responsibility to drop my classes as Rensselaer will not automatically cancel my registration.
I understand that my Rensselaer bill will be posted online and that all billing notices will be sent to my Rensselaer assigned email address and that it is my responsibility to review and pay my bill before the due date on the bill.
I understand and agree that should I fail to pay any outstanding balances in full when due and thus my account becomes delinquent, a late fee of two hundred and fifty dollars ($250) for the semester in which I fail to pay will be assess as a result of my outstanding balance.
I further understand that when my account becomes delinquent, Rensselaer, in addition to assessing late fees, may: withhold future registration privileges or schedule adjustments; withhold diplomas; and/or withhold official transcripts.
I understand that if any portion of my account remains unpaid at the end of any semester in which I attend, my account may be placed with an outside collection agency for further collection efforts.
I understand that if Rensselaer Polytechnic Institute retains a collection agency and/or attorneys to collect amounts owed to them, I will be responsible to reimburse Rensselaer for the fees of any collection agency, which may be based on a percentage of the delinquent account balance (to a maximum of 40 percent of the delinquent account balance), and will also be liable for all attorneys’ fees and costs and expenses incurred by Rensselaer in its collection efforts. I further understand that my failure to pay may be reported to credit bureaus, which will negatively impact my personal credit scores
In addition, I agree to allow Rensselaer and its agents to contact me at any cell phone number that I provide now or use in the future, using automated telephone dialing systems, artificial or pre-recorded voice or text messages, or personal calls regarding my obligation to repay my debts to Rensselaer. I also authorize Rensselaer or its agents to contact me via my rpi.edu address or an email address that I provide to the University.

Yes – I agree to the terms above and wish to continue with course registration.

Electronic Signature of Applicant

I hereby certify that the information given by me on this application is complete and accurate in every respect, and that the information I have submitted as an applicant for admission is my own work. I understand and agree that any misrepresentation may be cause for denial or revocation of admission, or subsequent dismissal from Rensselaer.

Electronic Signature of Applicant

Rensselaer Polytechnic Institute (RPI)

Single Course Application

PLEASE SUBMIT THE FOLLOWING:

ADDITIONAL NOTES: