(U.S. citizens only.)
Last Name:______________________First Name:_____________________M.I._______
Address: (street)_________________(city)___________(state)_____(zip)_______(country)______
Is this a new address? Yes____ No____
Telephone: (day)___________________(evening)___________________(fax)___________________
If you live outside the U.S., please include the city and country codes.
E-Mail Address 1:_________________________________________________________
E-Mail Address 2:______________________________________________New?_______
Employer: __________________________Occupation:________________New?_______
| 5 Digit CRN # | Dept. | Course Title & No. | Section # | Units | Course Fee |
On-Campus_______ Off-Campus Site________ TV/Satellite________ Internet________
Information About Fees
Course Fee $_______ TV/Satellite Fee $_______ Misc. Fee $_______ Late Fee $_______
Total Fees $____________ Check/Money Order: (payable to CSUDH) $_______________
Credit Card: Visa_____ Mastercard_____ Cardholder____________________________
Card #______________________________ Exp. Date___________
Authorizing Signature:____________________________________
| In Person or by Mail: CSUDH Extended Education SCC B141 1000 E. Victoria Carson, CA 90747 USA |
By FAX: Fax completed form to : 310 516-3971 |
By Phone: Call: 310 243-3741 |
Important: Please Read
REFUND POLICY: Refunds are granted in accordance with the State refund schedule. If a course is canceled, the entire course fee will be returned. If you withdraw 24 hours prior to the first class meeting, 100 percent of the course fee will be refunded (less a $10 processing fee). If you withdraw after the first class and before 25 percent of the course has elapsed, 65 percent of the total fee will be refunded. After 25 percent of the course has elapsed, no refund will be made; however, a drop form must still be filed. A stop payment on a check is NOT an acceptable withdrawal from the course(s) and will result in a financial penalty.