PLEASE PRINT Last Name: First Name ______________ Term:
Admissions & Records
College of the Siskiyous, 800 College Ave., Weed, CA 96094
Phone: (530) 938-5500 - Fax: (530) 938-5367 Email: registration@siskiyous.edu
Community Education Registration
DIRECTIONS: This form can only be used with Community Education courses. If you wish to enroll in other courses
you must use the regular registration form. Please call (530) 938-5500 to submit payment.
Community Education is non- refundable as of the first day of class.
Registration Information
Term Registering For:
1. Personal Information
Last: First: Middle:
Date of Birth: COS Student ID Number:
2. Current Physical Address
Street: City: State: Zip:
Phone: Email:
3. Directory Information (AP 5040)
May the College release information regarding your attendance and residence to outside inquiries?
Yes No
Term:
Please list the courses you wish to attend, with CRN (Course Registration Number) and Course
CRN
Course
Course Title
Term:
Please list the courses you wish to attend, with CRN (Course Registration Number) and Course
CRN
Course
Course Title
I verify that I am responsible for the course choices listed above and that I have read any advisories in the COS Catalog.
The information on this application is true and correct to the best of my knowledge. Falsification of any information may
result in my dismissal from classes. I acknowledge I am responsible for payment of all fees related to the course(s) above.
Student Signature: Date:
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