Course Registration Form

                       

Semester

Year
Is this your first semester?
Yes   No
Will you graduate this semester?
Yes   No

OFFICIAL UNIVERSITY NAME
     

Name (First MI Last - Required)

Preferred or Nickname

   
Classification
   
Curriculum
   
Email Address (Required)

COURSES      
       
Department
Course Number
Credit Hours
Instructor
Department
Course Number
Credit Hours
Instructor
Department
Course Number
Credit Hours
Instructor

WORK ADDRESS
Only fill out if you are a new student or have changed your work address since the last semester  you enrolled.
 
Company
Title
Address
Address 2
City, State Zip
Phone Number

PROCTOR ADDRESS (Must provide by 5th class day) 
All students please provide Proctor name and address each Semester.
Proctor Name (First Last)
Address
Address 2
City, State Zip
Phone Number
Email Address

STUDENT'S HOME ADDRESS
All students please provide your home address, each semester
Address
Address 2
City, State Zip
Phone Number
 

Notes to Graduate Outreach Program

Click on the following link to submit