First-time Registration Form

Congratulations! You're one step closer to registering for a course with Brandeis Online. To start the process, please complete the form below. Upon submission, you'll receive an email with instructions on how to set up your Brandeis account and proceed with registration.

If you have questions at any time, please contact our enrollment advisors at 781-736-8787 or online@brandeis.edu.

Contact Information

First Name

Middle Name

Last Name

Preferred Name

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number

Email Address

Biographical Information

Birthdate

For purposes of this question, legal sex is defined as the current marker on your government identification documents. This includes things like your birth certificate, passport, state ID, or driver's license.

Legal Sex

We understand that gender identity can be expressed in a variety of ways. Should you wish to elaborate on your response in the above Biographical Information section, you are invited to respond to the following optional question concerning gender identity. Your response will not affect your enrollment.

Gender Identity

Citizenship

Permanent Resident

Yes

No

Social Security Number

Please carefully review the following statement and click the checkbox to state that you understand the statement.

For those students who are not U.S. Citizens or U.S. Lawful Permanent Residents (Green Card holders): Please be advised that the Division of Graduate Professional Studies, in the Rabb School of Continuing Studies, is unable to issue F-1, M-1, or J-1 non-immigrant student visas for its part-time graduate programs, in accordance with U.S. immigration regulations.

Individuals who hold visa statuses in the U.S. that also allow for pursuit of study (such as H-1B1, R-1, L-1, Trade NAFTA), may pursue coursework at the Rabb School provided they fulfill the terms, and maintain the validity, of this status while studying at the Rabb School. If a student is currently in the U.S. pursuing full-time study at another college or university, and holds an F-1, M-1, or J-1 student visa from that institution, s/he is advised to contact the Designated School Official/Responsible Officer at the sponsoring institution to obtain authorization to pursue study at the Rabb School, while simultaneously maintaining full-time student visa status at the original, visa-sponsoring institution.

I understand the above written statement.

Employer Information

Employer

Partners HealthCare Affliation

First-time Registration Form

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