INSTRUCTIONS Please fill out the following form completely. You will recieve email notification once your application has been reviewed and approved.
Last Name
First Name
Email Address
Address
City
State
Zip
Phone
Username (This will be the username you log in with)
Password
Re-Type Password
School Name
Department
Usual Enrollment
Course Name/Number
Please look back over the information provided to make sure everything is correct. If everything is ok, then click the SUBMIT button below