Please submit this form to the
address at the bottom of this page.
INTENT TO ENROLL FORM — For students accepted to the Associate of Science in Management Degree at the Katz School
STUDENT INFORMATION
Name__________________________________________________Date of Birth_________________
YU ID#______________________________
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Mailing Address__________________________________________________________________________________________________________
Street
City
State
Zip
Country
Home Phone______________________________ Cell_________________________________ Email_____________________________________
PROGRAM OF CHOICE (PLEASE CHOOSE EITHER OPTION A or B):
Students enrolling in YU are required to enclose the applicable deposits and completed medical forms.
l OPTION A: I will be attending YU in New York
I intend to enroll at the New York Campus and have enclosed a $550 nonrefundable deposit for enrollment and University
housing. Please note that University housing is required for all undergraduates for their first two semesters on campus.
I wish to attend starting l Fall 20 ___
l OPTION B: Other
l I would like to defer my admission
I wish to defer my admission to Yeshiva University until Fall ______________________________ in order to: (select one)
l Study in Israel at the following school __________________________________________________________.
l Other (please specify) _______________________________________________________________________.
l Decline
I am declining Yeshiva University’s offer of Admission and will attend __________________________________________.
PAYMENT INFORMATION (PLEASE DO NOT SEND CASH)
Please note that this request can only be processed once the deposit is received.
STUDENT NAME ___________________________________________________________ YU ID # ________________________
l Check or US money order payable to Yeshiva University is enclosed.
l MasterCard l Visa
Cardholder’s name _________________________________________ Telephone ____________________________________
Credit Card number ________________________________________ Exp. Date _____________________________________
Security Code (last three digits in signature box on the back of the credit card) _____________
Amount to pay: l $550
500 West 185th Street, New York, NY 10033 • P: 646.592.4440 • F: 646.390.1816 • [email protected]
5/2017