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Extension Online Registration Form

Use this form to register for Extended Education classes and pay online. If you do not wish to pay online, or if you are having trouble with this form, please use the downloadable form and mail it to the address at the bottom of this form (Adobe Reader required). You may also call 707-826-3731 to register with a credit card (Visa, MasterCard or Discover).

NOTE: This form cannot be used to submit Open University, Graduate Continuous Enrollment, or Summer Session registrations.

Student 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: Humboldt ID (or Social Security Number) 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.

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

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

required

Race/Ethnicity Information

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:

 
Courses

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

Course 1
Course 2
Course 3
Enter another course


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