Special Student & Certificate Student Registration Form

Special Student & Certificate Student Registration Form- Spring 2015 Enrollment

General Registration will be OPEN for Spring 2015 from January 19th - January 31st.
Full Name

First NameLast Name
Gender
Ethnicity
Religious Affiliation
Are you an Alumni, Spouse, or Partner?
What year did you graduate?
What is the full name of your spouse/partner?
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Social Security Number
(for tax purposes) numerals only; no dashes
Birth Date

MonthDayYear
Institution of Affiliation
SPRING 2015 RESIDENTIAL courses you'd like to take
HM 4005 PIN number
HR 4002 PIN number
SPRING 2015 RESIDENTIAL HYBRID courses you'd like to take
RFST 2130 PIN number
HR 4002 PIN Number
SPRING 2015 ONLINE courses you'd like to take
CEST 8450 PIN number
RSFT 2130 PIN number
CERA 8422 PIN number
HRPS 8322 PIN number
HR 8401 PIN number
PS 8450 PIN number
HRRS 8420 PIN number
RSFT 8418 PIN number
RSFT 8420 PIN number
HSFT 8462 PIN number
HRHS 8450 PIN number
HRHS 8454 PIN number
Total Number of Units
Grade Type
Moodle ID Status
For Office Use Only
Term
Course
Professor
Amount Due
Amount Paid
Check Number
Check Date
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- Should be Empty:

Special Student & Certificate Student Registration Form- Spring 2015 Enrollment