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M.S. MHC Residency



First Name:*
Last Name:*
Last 4 Digits of SSN or Student ID Number:*
Street Address:*
City:*
State/Province:*
Country:
Postal Code:*
Home Phone:*
Work Phone:
Fax :
Email Address:*
Verify Email:*







This residency will serve as my:*
1st Residency
2nd Residency (If this is your 2nd residency please return to the MS MHC Residencies page and fill out an MS MHC Residency 2 form)





I have read and agree with all Policies and Procedures*

I understand that the residency program requires all students to be present according to guidelines outlined in the Residency Confirmation Email.*



I understand that I will be billed $1,230 for the residency fee (billed to my tuition bill). All travel, lodging and meals are my own expense.*

I understand that the last day to cancel this residency and receive a refund is 10 days prior to the start of the residency.*

I plan to bring my laptop computer.

My laptop computer has wireless Internet capability.

I am planning to make hotel arrangements under the Walden University room block.


Individuals with disabilities who would like to request accommodations should contact Disability Services at 1-800-925-3368, Ext. 1221, or mail to disability@waldenu.edu

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