Student Information

* = Required field

  

/Region*

(include area code)

Please answer the following:

Male    Female
YES     NO
List all previous names you have used. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)
YES     NO
I am a:*
(Check any that apply)




:

Please supply the following information: Social Security Number/HSU ID and Date of Birth
This information is submitted via SECURE SERVER, and is requested pursuant to
Section 41201, Title 5, Calif. Code of Regulation and Section 6109 of the Internal Revenue Code.
Social Security Number (or HSU ID) (000 -  00 - 0000):*    -   -

Your date of birth is requested so that Humboldt State University may identify records that are unique to you.
*

Class Selection

ACADEMIC CREDIT: YOU MUST PROVIDE YOUR HSU ID OR SSN WHEN YOU REGISTER [see above]

DEADLINES: Registrations received after 5 p.m., Mon., May 1, will be charged a late fee of $25.
No current term online registrations will be accepted after 5 p.m., Fri., May 12.

To request retroactive credit (for terms up to one year prior to the current term),
please begin the process by contacting the Teacher Induction office:
(707) 524-2818 during business hours. Allow up to four weeks for your request to be processed.

YEAR 1

To register, check the box next to the course credit option.
FEE
NCTIP Candidate #2 (3 units, $150)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27231
SED (Secondary Education) x701, 27237
SPED (Special Education) x799, 27243


$
$
$

NCTIP Mentor Teacher #2 (2 units, $100)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27233
SED (Secondary Education) x701, 27239
SPED (Special Education) x799, 27245

$
$
$
NCTIP Mentor Teacher #6 (2 units, $100)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27235
SED (Secondary Education) x701, 27241
SPED (Special Education) x799, 27247

$
$
$

YEAR 2

To register, check the box next to the course credit option.
 
NCTIP Candidate #4 (3 units, $150)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27232
SED (Secondary Education) x701, 27238
SPED (Special Education) x799, 27244

$
$
$
NCTIP Mentor Teacher #4 (2 units, $100)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27234
SED (Secondary Education) x701, 27240
SPED (Special Education) x799, 27246


$
$
$

NCTIP Mentor Teacher #8 (2 units, $100)
CHOOSE ONE CREDIT OPTION :
EED (Elementary Education) x701, 27236
SED (Secondary Education) x701, 27242
SPED (Special Education) x799, 27248


$
$
$

Professional Development/Clear Credential

 

PLEASE NOTE: You must be enrolled in the Health Course through the North Coast School of Education (NCSOE) BEFORE you can register for the following course with HSU. Please call 707-524-2818 with questions.

Health Course for Educators, EDUC x705, 1 unit, 27230: $50

$

Late Fee

 
Late Fee ($25):
A late fee will be charged if your registration is submitted after 5 p.m., May 1. Late registrations accepted online only until Thursday, 5 p.m., May 15.
$

TOTAL TO BE CHARGED

TOTAL FEES: This is the total of all fees which will be charged to your credit card.
You will enter your payment information after submitting this form.
$

You must enter the image characters below before you can submit this form.

If you cannot read the characters shown, click on the Refresh icon  refresh symbol below until you see an image that you can read.

Alternately, you can click the Speaker icon symbol to hear an audio of the characters. Type what you hear in the box.

If you are still having difficulties, please call 707-826-3731 to register over the phone. (Monday-Friday, 8 a.m.-5 p.m.)

Please review the above information for accuracy before submitting this registration form.

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