Class
Number
Course Title
Class Dates
Instructor Name Fee
Registration Form
Fresno State ID_______________________ OR Social Security Number
_________________
Date of Birth_______________________
Country of Citizenship:_________________________ (for tax deduction/credit purposes)
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 Visa Other Visa____________________
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/Certicate Number (Required for CEUs) Type of CEU Requested (Required for CEUs)
Male Female
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,
Visa, 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 ONLY.
CASH PAYMENTS ARE NOT ACCEPTED IN THE CONTINUING AND GLOBAL EDUCATION OFFICE
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.
Payment Information
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 certies 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.
Summer 2015
Kremen Education Building, Room 130
559.278.0333
www.fresnostate.edu/cge
Additional Course Fees (if any)
(See Program Changes/Withdrawals/Refund Policy, etc. on Reverse Side)
(please print clearly in black or blue ink)
TB-7/14
3
50685 Protecting Your Ideas: 8/5/15 Sherrie Flynn 125.00
Intellectual Property Law for
Entrepreneurs
125.00
click to sign
signature
click to edit
1 American Indian or Alaskan
native
2 Black, Non-Hispanic, including
African-American
3 Mexican-American, Mexican,
Chicano
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
Ethnic Group Identication
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.
Registration:
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 ofcial withdrawal nor relieve you of your nancial obligation to the University.
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 justied by sufcient 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 ve 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 ofce 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 rst class meeting has taken place.
Intersession Courses:
Refer to http://www.fresnostate.edu/cge/intersession.
Summer Session Courses:
Refer to http://www.fresnostate.edu/cge/summersession.
6 Other Pacic
Islander
7 – White
F – Filipino
8 – Other
9 – No response
D – Decline to state