College of eLearning & Extended Education
Student & Business Services Building, Suite 211 (open Mon.-Fri., 8 a.m.-5 p.m.)
Humboldt State University 1 Harpst St. • Arcata, CA 95521-8299
phone 707-826-3731 e-mail firstname.lastname@example.org
NOTE: With the exception of eLearning courses, do not submit Open University
or Graduate Continuous Enrollment registrations via this form.
Open University registrations must be entered on the downloadable
form and brought to the first class meeting.
The instructor's signature along with departmental approval is required
prior to Extended Education processing the registration.
Return the signed form with payment as soon as possible. Refer to the current
to avoid late fees.
Those registering for OLLI courses should use the OLLI registration form.
you do not wish to use this on-line registration form, or if you are having
trouble with it, please use the downloadable
Fill out the form and mail it to above address. (Adobe Reader required)
* = Required field
sensitive 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.
Why do we ask for your Social Security Number? (opens new window)
Your date of birth is requested so that Humboldt State University may identify records that are unique to you.
Enter your date of birth:*
Year (4 DIGIT):
[Your voluntary response is requested to comply with Federal and State legislation.]
If the California State University system is asked to report only ONE summary race/ethnicity
description for you, choose the ONE category below that you want us to report:
Enter the course information for each course you want to take.
Enter numerals only
review the above information for accuracy before submitting this registration form.
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information call (707-826-3731), fax (707-826-5885), or e-mail eLearning & Extended Education.