Continuing Education Registration Form

Continuing Education Registration Form

This form should be used if the course is no longer available for online registration.

First Name

Last Name

Email

NetID

Date of Birth

Street Address

City

Zip

State

Phone Number

Gender

Program

Term

Course Start Date

Course Number

Course Section

Course Title

Add another course?

YesNo

Course Start Date

Course Number

Course Section

Course Title

Add another course?

YesNo

Course Start Date

Course Number

Course Section

Course Title

Add another course?

YesNo

Course Start Date

Course Number

Course Section

Course Title

For details about our Withdrawal and Refund Policy, visit our Registration Policies website.

We will contact you when your registration form has been received, and payment will be due at that time. Payment must be received in full for enrollment to be valid.

Failure to pay fees within 48 hours of enrollment will result in being dropped from courses.

Please indicate your intended payment option below.

Personal check or money order payable to CSUEBOnline payment by credit card or electronic checkPaid by employerThird Party Payment (WIA, DOR, AmeriCorps, etc.)