Enrollment Form 

Symposium University

The Globe’s Leading Virtual University

www.symposiumedu.org

[email protected]

If you have questions, please contact us at 888-506-1106

Please PRINT this form.  Fill it out.  Scan it.  Send as an email attachment!


Name: ____________________________________________________________________________________________________

Program/Degree/Selection: __________________________________________________________________________________

Mailing Address: ___________________________________________________________________________________________

Email Address: _____________________________________________________________________________________________

Phone Number: ____________________________________________________________________________________________

Occupation: _______________________________________________________________________________________________

Prior Education/Degrees/Certifications: _______________________________________________________________________

___________________________________________________________________________________________________________


Payment Information for Credit Card or Debit Card

Name on Card: _____________________________________________________________________________________________

Address of Card Holder: _____________________________________________________________________________________

Credit or Debit Card Number: ________________________________________________________________________________

Expiration Date on Card: ____________________________________________________________________________________

Three Digit Security Code from Back of Card: __________________________________________________________________

I authorize payment of $98 for the Enrollment Fee. Please initial here ________

I authorize SU to charge my credit card, debit card. Please initial here ________

I authorize SU to charge my credit/debit card for the $250 graduation fee upon completion of my program _______


Please initial the line which represents your selection of payment option.

Discounted tuition after $5,000 Tuition Scholarship, if eligible.


Bachelor: $  9,389 - $5,000 =  $4,389   ______         or 12 months at $413  ______         or 18 months at $298   ______

Master:    $11,389 - $5,000 =  $6,389   ______         or 12 months at $585  ______         or 18 months at $405   ______

Doctor:    $13,389 - $5,000 =  $8,389   ______         or 12 months at $747  ______         or 18 months at $516   ______      or 24 months at $441  _____

Enrollment Fee of $98 is in addition to tuition.

Graduation Fee of $250 is in addition to tuition.


Cancellation Policy

The Enrollment Fee of $98 is nonrefundable. Once the Proprietary Program Guide/Catalog has been released 

to the student, there are no refunds. If a payment plan is selected, the student is obligated to complete the 

payment plan. Tuition payments are non-refundable.  I agree with the above terms and conditions. 

 Please accept my enrollment as a member of SU.


_______________________________________ Date: ____________________________

Signature