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OLLI at Humboldt - Follow your passion with Lifelong Learning - Osher Lifelong Learning Institute

Osher Lifelong Learning Institute (OLLI)
Registration Form

Use this form to join OLLI, renew your membership, and/or register for courses.

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Participant Information

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Select your gender:

Have you ever been enrolled at Cal Poly Humboldt?*

Have you completed a Bachelor's Degree or higher?*

Secure Information

Please supply the following information.
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.

Humboldt ID or Social Security Number (000-00-0000):*

Date of Birth

Your date of birth is required so that Cal Poly Humboldt may identify records that are unique to you.

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Membership Status

Select one membership option. *

Nonmembers: By checking "Nonmember" in this section, a $25 per course nonmember fee will be automatically added for each course you list on this form.

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Enrollment

Enter the course information for each course you want to take. Click "Add another course" to register for more than two courses.

Courtesy membership redemption details may also be entered below.

Course 1

Course 2
Add another course

Payment of Fees

* Please select how you want to pay your fees. If you will not pay online upon submitting this form, please select one of the other payment options. If you don't owe a fee, check "no payment is due."

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