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: No online registrations will be accepted after 5 p.m., Fri., Aug. 18.

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

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 Health Course for Educators with HSU. Please call 707-524-2818 with questions.

Health Course for Educators, EDUC x705, 1 unit (31343): $50

$

TOTAL TO BE CHARGED
This is the total of all fees which will be charged.
You will enter your credit card or electronic check 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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