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Student s Last Name Open University Registration Form IMPORTANT You must obtain both the instructor s and department chair s signature on your registration form in order to enroll through Open University or to drop your Open University course. After you have obtained the required signatures submit the form to the College of Continuing Education Records office in Napa Hall. Please refer to the Open University Information Sheet for registration deadlines and withdrawal procedures for each term. PLEASE PRINT CLEARLY ALL INFORMATION BELOW Fall Spring Sac State ID Summer Social Security Number First Name Year Legal Name Last First MI D I R E C T O RY I N F O R M AT I O N Street Address Day Telephone Number Date of Birth mm-dd-yy City State Zip Evening Telephone Number Sex Female M. I. Male Do you currently have a Bachelor s Degree Yes No E-mail IDENTITY CODE OPTIONAL Enter your ethnic identity code in the box. 1 - American Indian or Alaskan native tribe 2 - Black non-Hispanic including African-American 3 - Mexican-American Mexican Chicano A - Central American B - South American Q - Cuban P - Puerto Rican 4 - Other Latino Spanish-origin Hispanic C - Chinese J - Japanese K - Korean R - Asian Indian 5 - Other Asian M - Cambodian L - Laotian V - Vietnamese T - Thai S - Other Southeast Asian G - Guamanian H - Hawaiian N - Samoan 6 - Other Pacific Islander 7 - White F - Filipino 8 - Other Are you an International Student yes no If yes what type of visa do you hold List Below All Courses You Wish To Register For Check one 1. Add Audit Drop Class Office Use Only Dept. Course Section Units Print Instructor s Name Instructor s Signature Unit Type Department Chair s Signature 2. Add 3. Add Date REG By CON Tuition Parking Decal No* Late Fee I understand that this enrollment does not constitute admission to the University. I have read the information and registration procedures and understand the procedures of withdrawal and fee refund policy. If taking a graduate level course I have a baccalaureate degree if not I have informed the instructor that I do not have a baccalaureate degree. Total Units Sponsor OPU04F06FO - OpenURegForm TOTAL PAID Accounts Receivable Student s Signature GRAND TOTAL Date Registration Submitted. I. Male Do you currently have a Bachelor s Degree Yes No E-mail IDENTITY CODE OPTIONAL Enter your ethnic identity code in the box. 1 - American Indian or Alaskan native tribe 2 - Black non-Hispanic including African-American 3 - Mexican-American Mexican Chicano A - Central American B - South American Q - Cuban P - Puerto Rican 4 - Other Latino Spanish-origin Hispanic C - Chinese J - Japanese K - Korean R - Asian Indian 5 - Other Asian M - Cambodian L - Laotian V - Vietnamese T - Thai S - Other Southeast Asian G - Guamanian H - Hawaiian N - Samoan 6 - Other Pacific Islander 7 - White F - Filipino 8 - Other Are you an International Student yes no If yes what type of visa do you hold List Below All Courses You Wish To Register For Check one 1.

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