Cal Poly Humboldt LogoCal Poly Humboldt

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

Osher Lifelong Learning Institute (OLLI)
Registration Form

Use this form to register and pay for OLLI membership and courses.

If you do not wish to register or pay online, or if you are having trouble with this form,
please download a PDF registration form. (Adobe Reader required)
Print and fill out the PDF form and mail it to OLLI at Humboldt
College of Extended Education & Global Engagement, Cal Poly Humboldt
1 Harpst St., Arcata, CA 95521

* = Required field

Participant Information

* = Required field

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.


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.

Course Selection

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

NOTE: The OLLI Back to Camp program is not open to nonmembers. Please select a Current, New, or Renewing membership option above.

Course 1

Course 2

Before you submit this form

Please check the box to confirm you are a human before you submit this form.
You may also be required to verify one or more Recaptcha images. Thank you for helping us prevent spam.