Registration Form
Fresno State ID_______________________ OR Social Security Number
__________
Date of Birth_______________________
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 *Best Contact Phone (with area code)
*These will also be used in case of class cancellation.
Signature______________________________________________ Date__________________
Total Fees $
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.
Grading Option
Letter CR/NC
Class
Number
Course Title
# of
Units
Instructor Name
Fee
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, rm,
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
nancial aid, and/or related to perjury proceedings. My signature certies 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.
PLEASE INDICATE
Fall 20____
Winter 20____
Spring 20____
Summer 20____
Kremen Education Building, Room 130
559.278.0333
www.fresnostate.edu/cge
Permission #
Additional Course Fees (if any)
(For policies and procedures, visit fresnostate.edu/cge)
Please visit: www.fresnostate.edu/cge/registration
for online registration instructions.
(please print clearly in black or blue ink)
Course
(e.g. HS 302)
TB-3/16
(for tax deduction/credit purposes)
If there is a hold on your University account, you will not be permitted to enroll until all holds are cleared.
(Title 5, California Code of Regulations, Sections 42381)
CREDIT COURSES ONLY
PAYMENT INFORMATION
If making payment online or at the Cashier Windows, please make sure your payment is receipted as a Continuing and Global Ed payment.
Dishonored checks: WRITING A BAD CHECK IS AGAINST THE LAW. BAD CHECKS AND STOPPED PAYMENTS ON CHECKS WILL
RESULT IN A $20 DISHONORED CHECK FEE. BAD CHECKS AND STOPPED PAYMENTS ON CHECKS DO NOT CONSTITUTE AN
OFFICIAL WITHDRAWAL NOR RELIEVE YOU OF YOU FINANCIAL OBLIGATION TO THE UNIVERSITY.
ONLINE PAYMENTS: (1) E-PAY (electronic check) (2) SmartPay (AmericanExpress/Discover/MasterCard/VISA credit card only)
Please note that a service fee of 2.75% is charged when you pay online with a credit card. Sign in to My Fresno State at my.fresnostate.edu
Click on SelfService/StudentCenter/MyFinances, then select the “View eBills/Make A Payment” button. Follow the link to “Make Payment” for
processing your payment.
PAY-BY-MAIL: Check/Money Order ONLY. Make payable to FRESNO STATE. Write your Fresno State ID number on your check/money
order. Return payment with this form to: Continuing and Global Education, 5005 N Maple Avenue m/s ED76, Fresno CA 93740-8025.
PAY-IN-PERSON: Go to the Cashier Windows(south lobby of the Joyal Administration Building) between 8:00 am and 4:30 pm, Monday
through Friday. (1) Credit Card Payments: You may pay using MasterCard and Visa ONLY. There is no service fee charged at the Cashier
Windows. (2) Check/money orders made payable to FRESNO STATE. (3) Cash. Please have your Fresno State ID number.
CASH PAYMENTS ARE NOT ACCEPTED IN THE CONTINUING AND GLOBAL EDUCATION OFFICE.
Do you have a bachelor’s degree? Yes No
Male Female
click to sign
signature
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