Humboldt State University

College of eLearning and Extended Education


Extension Online Registration Form

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   extended@humboldt.edu

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 semester's calendar to avoid late fees.

Those registering for OLLI courses should use the OLLI registration form.

If you do not wish to use this on-line registration form, or if you are having trouble with it, please use the downloadable form.
Fill out the form and mail it to above address.

* = Required field

Student Information

NOTE TO YAHOO.COM E-MAIL USERS: We are currently experiencing difficulty receiving registrations from those using Yahoo e-mail accounts. We encourage you to use an e-mail account other than Yahoo, or call us directly at (707) 826-3731. We apologize for the inconvenience.

Country*          

Please answer the following:

:*
YES     NO
Male    Female
YES     NO
YES     NO

Additional Student Information

This 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:*                      

If any of your courses include academic credit, you MUST provide the following:

HSU ID NUMBER or Social Security Number
(000 -  00 - 0000):*   -   -

Race/Ethnicity Information

[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:


Course Information

Enter the course information for each course you want to take.

Units
Subject Area & Catalog Number
Class Number:
5-digit code
Instructor's
Last Name
Course Title/Topic

Fees*
Enter numerals only

$
$
$
$
$
 
Total Fees for Classes
$
I.D. Fee
$
Materials Fee
$
Late Fee
$
TOTAL FEES *
$

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

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NOTE: If form will not submit, please scroll up to review that you have entered all the required information into the form.


Back to Registration Information on the HSU eLearning & Extended Education website

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For additional information call (707-826-3731), fax (707-826-5885), or e-mail eLearning & Extended Education.