Blackburn College Registration Form for Summer 2018 Courses

Step-by-step procedure
1. If you are a current Blackburn student you must see your Academic Advisor or the Records Office to register for Summer courses.

2. All others, please provide all required information on the following form. Incomplete forms cannot be processed.

3. If you are registering for a class with prerequisites, you will need to email proof of prerequisites to records@blackburn.edu or contact the Records Office (217) 854-5772.

4. Once completed, this form will be processed within three (3) business days. At that time payment arrangements can be made at the Blackburn College Business Office. They cannot accept payment until your registration form has been processed.

5. After registration is complete, any course changes can be made through the Records Office.

Questions? Contact the Blackburn College Records Office.
Student Information
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Day Phone
xxx-xxx-xxxx
Your answer
Cell Phone
xxx-xxx-xxxx
Your answer
Email Address
Your answer
Demographic Information
Gender *
Required
Ethnicity
(optional)
Prior Education Information
Did you graduate from high school?
If YES, date of graduation
MM
/
DD
/
YYYY
Name of High School
Your answer
Location of High School
City, State
Your answer
If NO, Did you complete the GED?
Date of GED
MM
/
DD
/
YYYY
Have you previously attended Blackburn College?
If YES, provide dates of attendance.
If you attended Blackburn under a different name (maiden or married) please include that name here.
Your answer
Have you previously attended another college or university?
If YES, provide the name of the college(s) and university(ies).
Your answer
Degree(s) earned, if any:
Your answer
For information on withholding directory information contact the Records Office.
For Our Information
How did you hear about Blackburn's Summer Sessions?
Course Selection
For course descriptions, dates, times or course delivery format (online, blended) visit our website to consult the Summer 2018 Course Offering. Check the box next to the course you would like to enroll.
What about Payment?
Tuition cost per credit hour for Summer 2018 courses is $226 per credit hour, or a total of $678 for each 3 credit hour course. The Blackburn Business Office offers a three (3) installment payment plan for Summer tuition. Full payment, or payment arrangements, must be made prior to beginning your class to guarantee space in the course. If you register for a class and decide not to attend the class please notify the Records Office to drop the course. All registrations that have not been paid, or payment arrangements made, will be dropped within the first five (5) days after the course has begun.

You must agree to the following to register for courses at Blackburn College: I understand I am responsible for all applicable Blackburn College academic regulations, tuition and fees whether or not I successfully complete the course or courses in which I am enrolling. I promise to pay attorney’s fees and other reasonable collection costs necessary for the collection of any amounts owed Blackburn College.
Please acknowledge: *
I understand and agree to this Blackburn College policy.
This Summer session registration you submit will be processed within three (3) days. After the form is processed, you will be issued Blackburn College Student Portal and Blackburn email credentials which will be mailed to you via USPS. Log in instructions will be enclosed with your credentials.

Tuition payment can then be made once your form has been processed by contacting the Blackburn College Business Office at (217) 843-5515 for details of payment plan or to provide your credit card information. Please do not call the Business Office as soon as the form is submitted as they can only accept payment for processed registrations.

When you click “submit” you should receive a “Thank You” message and the form has been successfully submitted. If you do not receive the message, scroll the form for any missing information that is requested. Once completing the requested information you must click “submit” again.
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