Class
Number
Course
T
itle
Class
Dates
CREDIT COURSES ONLY
Instructor Name
Fee
Course
(e.g. HS 302)
# of
Units
Grading Option
Letter CR/NC
Permission #
Kremen Education Building, Room 130
559.278.0333
www.fresnostate.edu/cge
Registration Form
(please print clearly in black or blue
ink)
Fall
20
Winter
Intersession 20
Spring
20
May-June Intersession 20
Summer 20
Fresno
State
ID
OR Social Security Number
Date
of
Birth
Country of Citizenship: (for tax deduction/credit purposes)
Male Female
If a U.S. citizen, or permanent resident check one:
U.S. Citizen
Naturalized Refugee/Asylum Immigrant 1-551 (Green Card) If a
Non-Immigrant Visa Holder, check one:
F-Visa (student) H1 Visa J Visa TN
V
isa
Other
V
isa
Last Name First Name Middle Name
Print any other name(s) you have used at California State University, Fresno
Mailing Address Apt. No. City/State/Zip
Email Address Daytime Phone (with area code) Other Phone (with area code)
In
case
of
class cancellation, please notify me
by:
Email Phone
Do you have a
bachelor
s
degree?
Yes No
Professional License/Certificate
Number (Required for CEUs) Type of CEU Requested (Required for CEUs)
(See Program
Changes/Withdrawals/Refund
Policy, etc. on Reverse Side)
Additional Course Fees (if any)
I have read and understand the Continuing and Global Education policies regarding registration and program
changes/withdrawals/refunds.
I
understand that enrolling in Continuing and Global Education courses does not constitute admission to the University.
Total Fees $
I certify under penalty of perjury under the laws of the State of California and the United States of America that I have provided complete and accurate responses to all the items. I authorize
California State
University
to
release
any
information submitted
by me to any
person,
firm,
corporation, association,
or
government agency
to verify or
explain
the
information
I
have
provided, to
obtain other
information
necessary
for
use
by California State
University concerning
my
enrollment
or any
application
I
have
submitted
or may
submit
for
admission, administration
of financial
aid,
and/or related to perjury
proceedings.
My
signature certifies
the
accuracy
and
completeness
of the
information
that
I
have
provided
and
I
understand
that a
misrepresentation
or any
omission
may
be cause for denial or cancellation of admission, transfer credit, or enrollment. I agree to advise California State University Fresno in writing of any change/s regarding my citizenship and/or U.S.
residency, as long as I am a student at this institution.
Signature
Date
Payment
Information
If making payment online or at cashiers, please make sure your payment is receipted as a Continuing and Global Ed payment.
Check/Money Order (Check# ) made payable to Fresno State. Write your Fresno State ID on your check or money order. Return
payment with this form to: Continuing and Global Education, 5005 N. Maple Avenue M/S ED76, Fresno, CA 93740-8025.
Credit card payments: The University cannot accept credit card information in printed form, whether it is by mail or fax, due to the liability involved with the
sensitive information that is requested. If you wish to pay using a credit card, you have two options:
go to https://my.fresnostate.edu. Select Student Self Service > Student Center > Account Inquiry. You may pay using American Express, MasterCard,
or Discover cards ONLY. Please note that a service fee of 2.75% is charged when you pay online with a credit card. However, you may pay by
electronic check online with no service fee.
go to the
Cashier
s
Windows, Joyal Building,
between
7 am and 3:30 pm, Monday through Friday. You may pay using
MasterCard
and Visa ONL
Y
.
CASH PAYMENTS ARE NOT ACCEPTED IN THE CONTINUING AND GLOBAL EDUCATION OFFICE
TB-7/14
15
50621
Check
Class
50620
50619
Wksp 1: Govern Grant Wrtg
Wksp 2: Private Foundations
$125
D. Griffin
$125
7-31-15
7-24-15
D. Griffin
Wksp 3: Budgets, Costs, etc.
8-7-15
D. Griffin
$125
click to sign
signature
click to edit
Ethnic Group
Identification
Your voluntary response is requested so we may comply with the Federal Civil Rights Act of 1964 and the California Title IX Education Amendment of
1972. Please circle appropriate code.
1 American Indian or Alaskan
native
2 Black, Non-Hispanic, including
African-American
3 Mexican-American, Mexican,
Chicano
Registration:
A Central American
B South American
Q Cuban
P Puerto Rican
4 Other Latino,
Spanish-origin, Hispanic
C Chinese
J Japanese
K Korean
R Asian Indian
5 – Other Asian
M Cambodian
L Laotian
V Vietnamese
T Thai
S Other Southeast
Asian
G Guamanian
H Hawaiian
N Samoan
6 – Other
Pacific
Islander
7 White
F Filipino
8 Other
9 No response
D Decline to state
Registration is not permitted after the second day of class.*
*Please refer to Open University deadlines for Open University registration.
Online (Web-Enhanced/Web-Based) Courses (indicated by classnotes 15 & 17 in the class schedule):
Students planning to enroll in web-based or web-enhanced classes must have a Fresno State email account and ID in order to access
course information on Blackboard. If you do not have a Fresno State ID and free Fresno State email account, follow the steps at
http://www
.
fresnostate.edu/cge/registration/new.html. You may provide the ID to your instructor and request temporary access to Blackboard prior to
registration. This does not enroll you in the class; you must enroll during the enrollment period.
If you have a Fresno State ID and email account but cannot remember your username or password, contact the student Help Desk at
http://password.csufresno.edu
or call 559.278.7000 for assistance with reactivating your account.
If you have a Fresno State ID but do not have a Fresno State email account, go to http://email.csufresno.edu to create your free Fresno
State email account.
Dishonored Checks:
Writing a bad check is against the law. Bad checks and stopped payments on checks will result in a $20 processing charge. Bad checks and
stopped payments
on
checks
do not
constitute
an official
withdrawal
nor relieve you of your financial
obligation
to the
Universi
ty
.
Registration Holds:
If there is a hold on your university account, you will not be permitted to enroll until all holds are cleared. (California Code, Title V, Section
43281) A late fee will be assessed if holds are cleared during or after the late registration period.
Course Cancellations:
If a course is cancelled by the Division of Continuing and Global Education, all fees will be refunded; however, you must request this refund
by submitting a Program Change/Refund Form. Courses offered through the Division of Continuing and Global Education are conducted on
a self-supporting basis, therefore
we
reserve
the right to
cancel a course
if
not justified by sufficient
enrollment.
Withdrawal/Program Change/Refund Please note: NO REFUND IS MADE UNLESS YOU REQUEST ONE.
Form is online:
http://www
.fresnostate.edu/cge/forms
Regular
Credit
Courses
(5 or more
class meetings
and
online
and
arranged
classes lasting
five
days
or
more):
With submission of Program Change/Refund form, a full refund will be granted prior to the class start date. On or after the class start date,
65% of the fees are refundable until 25% of the course time has elapsed. No refund is made after 25% of course has taken place.
Short Credit Courses (four or fewer meetings and online and arranged classes lasting four days or fewer) and Non-Credit Courses:
With submission of Program Change/Refund form, a full refund will be granted prior to the class start date. No refund will be made after
class start date.
Online and CD-ROM Courses:
CD-ROM (VESI):
With submission of Program Change/Refund form, a full refund will be granted to participants requesting a refund within 30 days of the
registration date. All materials must be returned to VESI uninstalled in order to be eligible for a refund. No refund allowed after 30 days
past registration date.
Online Courses (VESI & Test Prep):
Once you log on to the course, no refund is available. Prior to logging on, you may request a refund by submitting a Program Change/
Refund form. A full refund will be granted to participants requesting a refund within 30 days of the registration date with submission of
completed Program Change/Refund form. No refund will be made after 30 days past registration date.
Open University Courses:
For complete information on adds, drops, refunds, and withdrawals refer to
http://www.fresnostate.edu/cge/openuniversity
or call 559
278.0333.
Submit
a completed Program Change/Refund
form to the
Continuing
and Global
Education
office by the
stated deadline.
A
65%
refund is available for drops/withdrawals received by the appropriate deadlines. No adds, drops, changes or refunds are permitted after the
stated deadline. Classes
that
meet
for
less
than
a
full
semester
are not eligible for
refunds
after the first
class meeting has taken place.
Intersession Courses:
Refer to
http://www
.fr
esnostate.edu/cge/intersession.
Summer Session Courses:
Refer to
http://www
.fr
esnostate.edu/cge/summersession.