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)

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
Only fill out if you are a new student or have changed your home address since the last semester  you enrolled
Address
Address 2
City, State Zip
Phone Number
Would you prefer your lectures via
DVD Streamed on the Internet ( Note: Students who select streamed video will receive a $50 rebate per course)
Where should DVD-Rs be mailed?
Home Work

Notes to Graduate Outreach Program

Click on the following link to submit