Personal Information

Required fields are marked with an asterisk.*

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First Name*	Last Name*
Middle Name*
Address*	City*
State*	ZIP*
Primary Phone*	Secondary Phone (optional)
Email*
Birthdate* (MM/DD/YY)	Birthplace
Are you a U.S. citizen?* Yes No	If no, are you a permanent resident? Yes No
Sex*	Marital Status*
Religion (optional)
College/University Attending*	Major
Have you attended Capital University before?* Yes No	If Yes, when?
Are you Hispanic or Latino? Yes No
Select one or more races American Indian or Alaska Native Black or African American Native Hawaiian or other Pacific Islander Asian White

Course Enrollment

STUDENTS USING FINANCIAL AID MUST GET A CONSORTIUM AGREEMENT FROM YOUR HOME INSTITUTION, GET THE NECESSARY SIGNATURES AND SUBMIT IT TO CAPITAL’S FINANCIAL AID OFFICE, WHERE IT WILL BE COMPLETED AND MAILED BACK TO YOUR HOME INSTITUTE. YOU MUST THEN PROVIDE AN OFFICIAL NOTIFICATION OF YOUR SUMMER TERM AID ELIGIBILITY TO CAPITAL’S STUDENT ACCOUNTS OFFICE PRIOR TO THE FIRST DAY OF CLASS, LETTING CAPITAL KNOW HOW MUCH FINANCIAL AID YOU WILL BE RECEIVING IN ORDER TO START CLASSES. FAILURE TO COMPLETE THESE STEPS MAY RESULT IN YOU BEING CANCELLED OUT OF YOUR CLASS.

Course Enrollment: (Tuition: $430 per semester credit)

First Term (May 20 - June 14)
Course	Credits	Fees
BIOL 280 General Microbiology/Immunology	4	$1,720
CHEM 101 Chemical Principles IA	4	$1,720
CHEM 231 Organic Chemistry I	3	$1,290
CHEM 233 Organic Chemistry I Lab	1	$430
CHEM 451 Biochemistry I	3	$1,290
MATH 230 Calculus I	4	$1,720
PHYS 220 General Physics I	4	$1,720

First Term (May 20 - June 14)

Second Term (June 18 - July 15)
Course	Credits	Fees
CHEM 102 Chemical Principles IIA	4	$1,720
CHEM 232 Organic Chemistry II	3	$1,290
CHEM 234 Organic Chemistry II Lab	1	$430
CHEM 454 Biochemistry II	3	$1,290
MATH 231 Calculus II	4	$1,720
PHYS 221 General Physics II	4	$1,720

Second Term (June 18 - July 15)

Please enter Comments or Questions below, call Miriam Miller at 614-236-6520 or visit http://www.capital.edu/summer-institute/ :

If this is the first time you are registering for Capital classes, a $25 application fee (nonrefundable) must be paid with this application. Online payment can be accepted at https://epay.capital.edu/C20501_ustores/web/store_main.jsp?STOREID=41 Institute courses are transcripted as Capital University courses. A letter of orientation will be sent to you before classes start.

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