Fall 2010 Letter Of Intent To Enroll
STUDENT CONTACT INFORMATION Lewis Student ID _______________________________
Please type or print
Student’s Legal Name __________________________________________________________________________________
City _________________________________________________ State _________ Zip Code _______________________
Home Phone Number _________________________________ Cell Phone Number _____________________________
E-Mail Address ________________________________________________________________________________________
Academic Major _______________________________________________________________________________________
I understand that this tuition deposit is not refundable after May 1, 2010. I also understand that my admission
may be subject to cancellation if I earn a grade lower than a “C” for coursework in which I am currently enrolled.
Student’s Signature Date
I will enroll as a: Freshman Transfer
Yes, I intend to enroll at Lewis University for the Fall 2010 semester. (Check the appropriate boxes.)
$100 tuition deposit only (I do not plan to live on campus.)
$200 total = $100 tuition deposit + $100 housing deposit
have included my check or money order made payable to “Lewis University” and
have included the student’s name and their Lewis Student ID (listed above) on the check.
No, I have made other plans.
have decided to attend another college or university (please specify) __________________________
plan to defer my admission to Lewis University for a future term. Please contact me.
have made other plans (please specify reasons) _____________________________________________
Office of Undergraduate Admission | One University Parkway, Unit 297 | Romeoville, IL 60446-2200
(800) 897-9000 | Office (815) 836-5250 | Fax (815) 836-5002 | www.lewisu.edu/admitted | firstname.lastname@example.org