Student Information

* = Required field


(include area code)

Please answer the following:

Male    Female    Decline to state
YES     NO
List all previous names you have used. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)
YES     NO
Please supply the following information: Social Security Number/HSU ID and Date of Birth
This 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.
Social Security Number (or HSU ID) (000 -  00 - 0000):*    -   -

Your date of birth is requested so that Humboldt State University may identify records that are unique to you.

Course Information

Enter the course information for each course you want to take.

Units Subject/Cat. # Class # Instructor's
Last Name
Course Title/Topic


Total Fees for Classes


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Please review the above information for accuracy before submitting this registration form.