Registration Form

Please complete and submit the following form. Registration will be fully processed upon receipt of your signed form.
* denotes required fields

About You


Contact Information


Emergency Contact Information


Who should we contact in case of an emergency?

Medical Information


Please list any allergies or other health information of importance to a physician evaluating you in case of an emergency

Additional Info


Code of Conduct


Please read the following and check the box below if you agree.

  1. Students are required to attend ALL class activities except in the case of an emergency.
  2. Students will be required to treat all other individuals with respect and courtesy at all times.
  3. Due to the nature of activity involved in class and labs students are expected to shower and follow standard oral and physical hygiene practices daily.
  4. No cigarettes, tobacco, alcohol, drugs or other illegal substances are allowed.
  5. No weapons of any kind are permitted.
  6. Students are not permitted in any other dorms on campus.
  7. Any willful destruction of property of the University of Virginia's college at Wise will result in dismissal.