2025 Winter Course Registration Form

Course Registration Form
Please ensure that you fill out your information accurately. If the information is incorrect, you will be required to resubmit your form. It is essential to keep this information up to date as part of maintaining accurate student records.
Student Information
Full Name*

First NameLast Name
Student ID#*
※ NOT SEVIS Number
Degree and Major*
Date of Birth*

MonthDayYear
Attended Year*
Attended Quarter*
Please select the correct quarter and month

※ Please update your contact information, including addresses and phone numbers, if there have been any changes.
Please check the below box if new address

New Address
Address*

Street Address

Apt, floor, and unit

CityState

Zip Code
Please check the below box if new phone number

New Phone Number
Telephone No. *
Email Address*
Please provide valid email address

Course Information
Choose your attending day (Select only ONE)
Read Carefully

1. Once a slot is marked as "None," you must select from the options currently available.

2. This operates on a first-come, first-served basis.

3. Submit this form Only Once.
Select your Online Class for Monday (choose one only).*

Contemporary Crime EssentialsBrain and Behavior

Responsibilities of the Student
By Signature below, I acknowledge and agree to abide by the following:
- To read the published prerequisites of the courses for which I register
- To comply with the refund / withdrawal policy printed on the enrollment agreement and current school catalog
- To abide by the rules and regulations governing student conduct published in the school catalog and the student handbook
Signature*

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Signed Date*

MonthDayYear
Date
Should be Empty:

Course Registration Form