University Without Walls

University Without Walls

Welcome to University Without Walls. To begin the registration process, please complete and submit the form below. A staff member will call you to complete and confirm your registration.
If you prefer to register by phone, or have any questions please call us at 1-877-819-9147.

There are no fees to enroll or participate. A suggested contribution of $5 per class session is welcomed and helps us continue to provide quality programs. Donations can be made online, by phone or by mailing a check. We appreciate your support.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Birthdate (must be 60 or older to participate)

MonthDayYear
Date
Gender*

FemaleMalePrefer Not to SayOther
Emergency Contact
Relationship to Emergency Contact
Live with Emergency Contact

YesNo
Name of Emergency Contact

First NameLast Name
Phone Number of Emergency Contact
Second Phone Number of Emergency Contact
Address of Emergency Contact

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Emergency Contact
example@example.com
How did you find out about University Without Walls?
I am registering*

MyselfOn behalf of a parentOn behalf of a spouse/partnerOn behalf of a friend
If you are submitting this form on someone else's behalf, please include your information directly below.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Are you a returning participant?*

YesNo
Are you an Upstate New York or out-of-state resident?

YesNo
I am registering for (how many?) Courses/Support Groups
Please list the title, weekday and time of each UWW program you wish to register for below. If the class you chose is already filled, you will be placed on a waiting list. Participants may register for up to 6 programs.
Title, Weekday and Time of Program 1:
Title, Weekday and Time of Program 2:
Title, Weekday and Time of Program 3:
Title, Weekday and Time of Program 4:
Title, Weekday and Time of Program 5:
Title, Weekday and Time of Program 6:
Title, Weekday and Time of Program 7:
Title, Weekday and Time of Program 8:
Please note all enrollments will be confirmed by phone. A staff member will call you within 3 weekdays. We look forward to speaking with you!
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