Class
Number
Course
T
itle
Class
Dates
CREDIT COURSES ONLY
Instructor Name
Fee
Course
(e.g.
# of
Units
Grading Option
Letter CR/NC
Permission #
Kremen Education Building, Room 130
559.278.0333
www.fresnostate.edu/cge
Register online for most credit courses.
Visit www.fresnostate.edu/cge/registration
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
8 am and 4:30 pm, Monday through Friday. You may pay using
MasterCard
and Visa ONL
Y
.
• CASH AND CREDIT CARD PAYMENTS ARE NOT ACCEPTED IN THE CONTINUING AND GLOBAL EDUCATION OFFICE
TB-7/14
click to sign
signature
click to edit
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