Community Scholar Class Registration Form

Current Personal Information
Course Selection
Course Summary
Complete

Please note that senior citizens who are requesting tuition waivers under the the Senior Citizens Higher Education Act must use the Senior Citizen Waiver Registration form instead.

Section One: Personal Information

Legal First Name

Middle Initial

Legal Last Name

Date of Birth (MM/DD/YYYY)

Address

Address 2

City/Town

State

ZIP/Postal Code

Daytime Telephone

Email Address

Are you a(n):

Undergraduate Community Scholar

Graduate Community Scholar

High School Student Community Scholar

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