Course registration form

2011-2012

Students:

1. Personal Information
First (Given) Name: Last (Family) Name: Date of Birth: E-mail Address: Mailing Address:
Street MM DD YYYY

2. School Information
Grade in Fall 2011: Current School (check one): Gender: M F

City

State / Province

Country

Phone Number:

3.Course Selection

Select the course(s) in which you’re interested in enrolling.

4.Signatures
Student:

Course registration forms must be signed by the student, a parent or legal guardian of the student, and either the student’s academic advisor or a school administrator.

MM

DD

YY

Student’s parent or legal guardian:
MM DD YY

Student’s academic advisor OR school administrator:
MM DD YY

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