INSTRUCTIONS / Please complete and submit this form to UCI's Graduate Division (see address above) to indicate whether you intend to register at UCI. Please print legibly.
NOTE: Even if you have informed your home department that you plan to register or not register, you should completeand submit this form to the Graduate Division.Submit this form to the Graduate Division by e-mailing it to , faxing it to 949-824-9096 or mailing it to the address in the upper left hand corner of this form.
Applicant Name: / UCI Student ID:
Last / First / Middle
Student Phone: / () - / Student E-mail Address:
Academic Department: / Major:
1. Quarter/Year you were admitted to begin study: Fall Winter Spring Summer
Year
2. Indicate your intention to register (or not to register) by placing an “X” in the box next to the appropriate sentence:
I intend to register at UCI for the Quarter/Year indicated above
I do not intend to register at UCI for the Quarter/Year indicated above
3. If you do not intend to register, is this because you are postponing your plans to attend any graduate school at this time (check one)?
Yes No (If “no,” please answer #4 below)
4. If you plan to attend another institution, please let us know the name of the institution below. Also, please indicate the most important factor in your decision by writing a “1” in the space to the left of that factor. If a second factor strongly influenced your decision, please write a “2” in that space.
I plan to attend rather than UCI because of:
Superior academic/research opportunities Location of the institution
Faculty reputation Personal reasons
Offer of admission to UCI was too late Other (please specify)
Offer of financial support from UCI was too late
Financial assistance from the institution______
in the form of
and the amount of $
UCI Graduate DivisionRevision date: 7/30/2012 Page 1 of 1