document.write('

<'); document.write('/tr><'); document.write('td align="left" valign="middle" colspan="1" nowrap="nowrap" style="word-wrap: none">If no, what is your current immigration status?What is your racial background? (Select one or more)<'); document.write('td valign="middle">

Enrollment Form

YOU MUST FILL OUT ALL REQUIRE'); document.write('D FIELDS TO SUBMIT YOUR ENROLLMENT SUCCESSFULLY.

Personal Informati'); document.write('on

First Name

Middle Name

Last Name

Street Address

City

<'); document.write('tr>

S'); document.write('tate

<'); document.write('/td>

Zip Code

Email Address

<'); document.write('table cellpadding="0" cellspacing="0" border="0">

<'); document.write('span class="formText">

Confirm Email Address

Phone Number

Demographic Inf'); document.write('ormation

Gender

	Male
	Female

Date of Birth

mm/dd/yyyy

<'); document.write('/span>

Are you a citizen of the United States?

	Yes
	No

Marital Status

Are you of Hispanic or Latino ethnicity?

	Yes
	No

	American Indian or Alaskan Native
	Asian
	Black or African American
	Native Hawaiian or other Pacific Islander
	White

Academic Information

Current School Attending

Have you taken a course through Taylor before?

	Yes
	No

How did you hear about us?

If other, please indicate sourc'); document.write('e in this field.

Whi'); document.write('ch course(s) would you like to register for? Please include course name and number of credit hours ('); document.write('BIB 109E, 3 hours).

By checking the box you are verifying that you are the person named in this course registra'); document.write('tion.

Yes I am

'); document.write('

Upon submitting this form, you'); document.write(' will be directed to our course catalog to register for courses and pay tuition. Do not use '); document.write('a debit card as the form of payment as the card will be charged twice due to system restrictions. Ru'); document.write('nning a debit card as a credit card will also result in a double charge. If a debit card is'); document.write(' used, a fee of $50 will be charged to the user in order to refund the double charge. Taylor Univers'); document.write('ity is not liable for fees associated with account overdraft.

I have read, understand, an'); document.write('d agree to this statement.

'); document.write('

');