M.A. Spanish Registration Form (Summer Only)

OFFICE USE ONLY:

DO NOT EMAIL THIS FORM - IT WILL NOT BE ACCEPTED OR PROCESSED.

Fill in, print (using button below), then mail or fax to: SSU Extended Education, 1801 E. Cotati Ave., Rohnert Park, CA. 94928

Permanent Residence:
(Check appropriate box)

Sonoma (0049)
Lake (0017)
Napa (0028)
Solano (0048)

Other
State (6000)
If not USA (7000)

Semester for which you are registering

Summer

Student ID#

Name: *

Address: *

City: *

State: *

Zip code: *

E-mail: *

Day Phone: *

Evening Phone:

Sex

Male
Female

Birthdate:

mm/dd/yyyy

Have you ever been enrolled at SSU before?

yes
no

Occupation

Title of Course(s) you wish to enroll in:

I have applied for financial aid:

yes
no

If yes, you must complete and sign an Authorization to Apply Financial Aid to Other Charges form and the Fee Voucher Promissory Note and return them both to the Registrar in Extended Education, Stevenson 1012.

I enclose:

Check
Money Order
VISA

MasterCard
Discover
American Express

Signature *

Date Signed: *

Cardholder's name *

Card # *

Exp. Date *

Mail to: School of Extended Education, Sonoma State University, 1801 E. Cotati Ave., Rohnert Park, CA 94928-3609.

$ Amount enclosed: *

Sonoma State University School of Extended Education