MPH Registration Request

MPH Registration Request

This form is only applicable to MPH students who need to register for courses.
*Please consult your MPH Academic Advisor prior to completing this form.
Date form was submitted

MonthDayYear
Date
Name

Last NameFirst Name
UIW Identification Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
UIW Email Address

Confirmation Email
Select Fall Term(s)
Select Spring Term(s)
Select Summer Term(s)
Fall Extended (16-week)
Fall Mini I (8-week)
Fall Mini II (8-week)
Spring Extended (16-week)
Spring Mini I (8-week)
Spring Mini II (8-week)
Summer (8-week)
Specify Term(s), Course(s), and CRN(s) to be added:
(ex. Fall Mini I, 45321, PUHL 6302; Fall Mini II, 32156, PUHL 6305)
Please ensure you are aware of the deadlines to add/drop courses. You can also access these deadlines 24/7 via the UIW Academic Calendar.
What funds will you be using to pay for the tuition/fees for the course?
Do you authorize UIWSOM to route a Cost of Attendance Adjustment to the UIW Office of Financial Assistance to reflect additional tuition that will need to be incorporated in your financial aid award package? **This will not automatically increase your loans to cover the additional tuition cost**
Would you like to request your federal loans be increased to account for the additional MPH tuition, and additional living expenses? If you select yes, please expect an email from the SOM Office of Enrollment Services with additional documentation to be signed.
By submitting this form, I confirm I have consulted my MPH Academic Advisor and authorize UIWSOM to register me in the course(s) requested above. I also confirm I am aware of the deadlines to add and/or drop the courses I requested.
Select the applicable semester
Summer 2026 Courses
Should be Empty: