Print, obtain instructor's signature, then deliver (or mail or fax) to:
Extended Education Registration
Stevenson Hall 1012
Sonoma State University
1801 E. Cotati. Ave.
Rohnert Park, CA 94928
fax: (707) 664-2613
Name:
Address:
City/State/Zip:
Day Phone:
Night Phone:
Social Security #:
Date of Birth:
Gender
Ethnic Code:
Class Level
Have you ever been enrolled at SSU before?
Yes
Occupation:
Will your tuition be reimbursed by your employer?
Yes
Where did you learn about this course?
Courses Requested:
Class #
Dept & Course
[Ex: LIBS800]
Title
Units
Fee
Approval Signature
Dept. Chair Signature (Nat.Science Lab only)
I agree to abide by the deadlines and policies governing
these courses. If my payment by check is not honored by the bank, I am
still responsible for all course fees.
Signature:
I enclose check/money order/VISA/MasterCard for:
Credit Card Number:
Expiration Date:
Cardholder's name:
Mark the single most important reason why you have enrolled in Open
University
Which of the reasons listed below best explain why you are taking
college courses? (mark all that apply)
n which subject area(s) are you most interestd in taking courses?
How did you find out about Open University enrollment?
Indicate the highest level of education you have completed
Who is paying for your course(s)?
Indicate your age group
Have you enrolled in open university prior to this semester?
yes
What is your residency status?
Do you plan to apply for admission to the University to work toward
a degree?
yes
Which category best describes your employment status?
Name of employer (optional):
Your position title (optional):
Print, obtain instructor's signature, then
deliver (or mail or fax) to:
Extended Education
Registration
Stevenson Hall 1012
Sonoma State University
1801 E. Cotati. Ave.
Rohnert
Park, CA 94928
fax: (707) 664-2613
