College of Extended Education & Global Engagement
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 firstname.lastname@example.org
NOTE: Please do not use this form to submit Extended Education, OLLI, Open University or Graduate Continuous Enrollment registrations.
you do not wish to use this on-line registration form, or if you are having
trouble with it, please use the downloadable
Fill out the form and mail it to above address.
* = Required field
List all names you have used at HSU. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)
area of interest/License Number (if applicable):
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:*
Year (4 DIGIT):
[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:
Enter the course information for each course you want to take.
SUBMIT THE FORM
Please review the above information for accuracy before submitting this registration form.
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