ADMINISTRATION FEE REGISTRATION FORM

   ATTENTION- these instructions must be followed:
1. DO NOT use nicknames. Use only your legal name AS SUBMITTED ON YOUR APPLICATION on all forms submitted to SLBC. Your academic file and all degrees issued will use that name.
2. Use proper capitalization of all information. Do not use all upper-case letters or all lower-case letters.


Fill out the following information and click 'Submit'.
* indicates a required field.


PERSONAL INFORMATION: 
*Original or Amended form: If you submitted an Application form anytime within the last 6 months or if you are an active student and you are submitting a change of info on your Application, please check Amended.  Otherwise, check Original.
Original
Amended
*Your full name exactly as submitted on your Application form:
*Today's Date- use the calendar:
Only students registered with our SLBC Moodle site were issued a User Name.
If you are not registered with that site, leave the next field blank.
If you were issued a User Name, enter it here:
*Your Email:
*Verify Your Email:
Phone:
( )   -
*Country where you currently live: Other:  
*Information Accurate:
Yes.
Comments:
500 characters remaining.
I verify that I understand that by submitting this form I am agreeing
to pay $15.00 USD per month as an Administrative Fee for as long as
I am pursuing my degree as a student of SLBC.
*By submitting this form I am agreeing to pay the monthly Administrative Fee:
Yes No