REGISTRATION FORM
(Please print firmly)
ID #
A
Name ___________________________________________________________
(Last Name)
(First Name)
Term:
 Fall
 Spring
 Summer
20_______
Campus:
 Florissant Valley
 Forest Park
 Meramec
 Wildwood
(MI)
Street Address ___________________________________________________________ City ____________________________ State ______ Zip Code ____________
E-mail Address ___________________________________  Personal  Business
Program of Study _____________________________________________
Will you be receiving any financial aid?
 Yes
 No
Office
Use Only
CRN
FA
Example
10446
Course
Section Hrs. Audit
Number
*
HST:101
635
Student Status:  General (1-18 hours)  Regular: Financial Aid or Degree Seeking (1-18 hours)
Federal financial aid recipients MUST go to Advising prior to registration.
You must select an option for each of the following:
My primary goal in attending (select one):
 Improve existing job skills
I expect to accomplish this goal by (select one):
 Taking selected courses
Home Phone _____________________ Business Phone _____________________
3
Total Hours
 Prepare for a new job
 Transfer courses
 Self-improvement
 Certificate program (CP, CS)
 Associate degree
Course Title
American History I
Day Class Meets
M T W R
F
Time
S
3-3:50 p.m.
Student Signature ______________________________________________ Date ______________
*If you choose to audit this course, please put an “X” in the Audit column.
Advisor/Counselor Signature ______________________________________ Date ______________
— OFFICE USE ONLY —
Comments:
Date Rec’d. ______________ By __________ Payment Due Date __________
11-100-030 9/11