Paralegal Program Registration Form

For your security, we no longer have a submittable registration form. 
Internet and email registration will not be accepted.
Please fill out this form, print it, and enroll by fax, mail or phone at the numbers and address below:

Extended Education
1801 E. Cotati Ave.
Rohnert Park, CA. 94928
tel: (707) 664 2394
fax:(707) 664-2613

County of permanent residence :
Social Security#
Date of Birth
Sex (enter M or F)
Name

last

first middle

 
Current Mailing Address
City
State
Zip
Day Phone
Evening Phone
Email address
Reimbursed by Employer? YES NO
If yes, Company
Company Address


Class level or degree held

Have you ever enrolled at SSU before ? YES NO

If Graduate, degree held Date earned

Where did you learn about this course?

Occupation:

Other

Ethnic Code: Your voluntary response to this question is requested so that we may comply with the
Federal Civil Rights Act of 1964 and the California Title IX Education Amendment.

Courses you wish to enroll in

Course Title Dept. & Course #
(e.g. BUS200)		 Class #
(0000)		 Units Fee

VISA MasterCard Discover American Express

For the amount of $

Card Holder's Name

Credit Card Number Exp. Date

Signature(only necessary if mailing or faxing)

Date

I agree to abide by the deadlines and policies governing these courses and am responsible for all course fees.

If you are mailing or faxing in this form please sign below (if using a credit card) or attach your check or money order to the form if mailing it in.

Mail to:
Extended Education Registration, Sonoma State University
1801 E. Cotati Avenue
Rohnert Park, CA 94928-3609
or FAX to: (707) 664-2613 after completing the bankcard information.