Active Suspension Registration Form

Please fill out the form below.

- indicates required field

First Name  

Last Name  

Student ID Number  L number found on Mane Card

Phone Number  

UNA Email  

Alternate Email

Major  if undecided, write-in Undecided

Write a paragraph explaining what happened that has led you to this point in your academic career and what you are doing, other than enrolling in Active Suspension, to advance your situation.  

Send Please make sure all required fields have been filled out correctly.