REGISTRATION FORM
Please complete ALL  elds.
FOR OFFICIAL USE ONLY
NonResident
Resident
UG
GR
TOTAL
CREDITS
Late fee?
NO
YES $50 $100
Student Accounts
OK to reg?
YES
NO
Financial Aid
Eligibility Review
YES
NO

new student

on leave

continuing
Evergreen ID# A Chosen Name
Legal Name
Last First Middle
I understand and accept the registration and payment policies of The Evergreen State College.
Signature
Date
Mailing
Address City State Zip
Phone
( ) Alt. # ( ) E-Mail
FOR OFFICIAL USE ONLY
INITIAL DATE
OFFERING TITLE
FACULTY SIGNATURE
IF REQUIRED OR ADDING AFTER THE QUARTER BEGINS
CRN
Course Reference Number
QUARTER
Fall, Winter, Spring, Summer
NUMBER
OF CREDITS
Emergency Contact Phone ( )
Name Relationship
Address City State Zip
Evergreen will release directory information such as permanent and local address(es), telephone number, enrollment con rmation and degree if earned, to outside inquires
upon request unless you indicate con dentiality. If you wish to keep your information con dential, please ask for the Request for Con dentiality of Directory Information form.
OFFERING TITLE
CRN
Course Reference Number
QUARTER
Fall, Winter, Spring, Summer
NUMBER
OF CREDITS
DROP REGISTRATION
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