Get (icn) Pre-registration Form - Distance Learning - Purdue University - Distance Purdue

Filling out the (ICN) Pre-Registration Form is an essential step for those interested in enrolling in distance learning courses at Purdue University. This guide provides straightforward instructions to assist you in completing the form accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the (ICN) Pre-Registration Form and open it in your preferred editing tool.
2. In the first section, provide your first name and last name along with your middle initial (MI) if applicable.
3. Indicate your gender by selecting either 'Male' or 'Female' from the options provided.
4. Enter your date of birth in the format of day/month/year.
5. Select your citizenship status by checking one of the given options: 'U.S. citizen', 'International student', or 'Permanent resident visa status'.
6. Report your ethnic origin by checking one or more of the options listed including 'Caucasian', 'African American', 'Asian/Pacific Islander', 'Hispanic', 'Native American/Alaskan Native', or 'Other'.
7. Respond to the question regarding your residency in Indiana by selecting 'Yes' or 'No' and entering the number of years you have been a resident if applicable.
8. Provide your email address, home phone number, cell phone number, and work phone number in the designated fields.
9. Fill out your mailing address where you will receive mail during the course session, including street, city, state, county, and zip code.
10. Answer whether you have applied or plan to apply for financial aid by choosing 'Yes' or 'No'.
11. If you require accommodations due to a disability, note that Purdue is committed to providing necessary assistance and contact them at the provided number.
12. In the 'Requested Courses' section, list the course name, originating institution, course prefix and number, credit hours, and delivery method. Purdue is indicated as the home institution.
13. Confirm your graduation status for the semester by checking the appropriate box.
14. Enter your academic advisor's name and their email address in the specified fields.
15. Indicate the semester and year for the courses you are requesting.
16. Review the certification statement, ensuring that all information is true, accurate, and complete, and understand the implications of providing false information.
17. Please provide your signature and date at the bottom of the form to authorize your submission.
18. Authorize Purdue University to share information by signing and dating the relevant section of the form.
19. E-mail the completed form to distancelearning@purdue.edu upon ensuring all information is accurate.

Complete your (ICN) Pre-Registration Form online today to begin your distance learning journey at Purdue University!