Application for Non-Credit and Continuing Education Classes

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Personal Information Social Security Number Why is this important? Enter SSN without dashes or leave SSN blank Title DoctorMisterMrsMs * First Name Middle Name * Last Name Suffix JuniorSeniorThe FourthThe SecondThe Third * Date of Birth  mm/dd/yyyy Gender Female Male Are you Hispanic/Latino? Yes No Race (optional) Amer Indian Or Alaskan Native Asian Black Hawaiian Or Pacific Islander White Country of Birth AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocoa (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's RepublicKorea, Republic OfKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former YugoslavMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMidway IslandsMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNiger NigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste TogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Country of Citizenship AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocoa (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's RepublicKorea, Republic OfKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former YugoslavMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMidway IslandsMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNiger NigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste TogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Employment Status: EmployedNot in Labor ForceUnemployed Login Information * Password 8-15 characters * Verify Password Please remember or record your password. Passwords are case-sensitive and must adhere to the following rules: The password must not contain your first name. The password must not contain your last name. The password must be between 8 to 15 characters. The password must be changed every 180 days. The password cannot match the last 24 passwords. The password must contain (3 of 4) of the following: At least 1 lowercase character. At least 1 UPPERCASE character. At least 1 number. At least 1 special character: (!#$%*+,-./:;<=>?@[\]^_`{|}~") * Password Reset Question Favorite Ice Cream FlavorThe Make Of Your First CarWhat Is The Name Of Your Favorite Aunt?What Is The Name Of Your Favorite Grandparent?What Is The Name Of Your Favorite Pet?What Is The Name Of Your Favorite Teacher?What Is The Name Of Your Favorite Uncle?What Is Your Favorite Color?What Is Your Favorite Drink?What Is Your Favorite Food?What Is Your Mother's Maiden Name?Who Is Your Favorite Movie Or TV Character? * Password Reset Answer

Contact Information * Mailing Address * City * Zip Code * State AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFederated States Of MicronesiaFloridaForeign CountryGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMarylandMassachusettsMichiganMilitary BaseMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IslandsNot ApplicableOhioOklahomaOntarioOregonPalauPennsylvaniaPuerto RicoQuebecQueenslandRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Virgin IslandsUnknown Or Student Not FticUtahVermontVirginiaWashingtonWest VirginiaWest YorkshireWisconsinWyoming * Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocoa (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's RepublicKorea, Republic OfKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former YugoslavMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMidway IslandsMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNiger NigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste TogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe * Home Phone (123) 123-1234 Work Phone (123) 123-1234 or (123) 123-1234 ext 1234 Cell Phone (123) 123-1234 E-mail Address Why is this important? Enter only one e-mail address   Immigration Information (To be completed by non US citizens only) * Immigration Status Applicant For AsylumAsyleeDiplomatic Visa (a1 Or A2)Exchange StudentF-1 Visa StudentOtherParoleePending Permanent ResidencyPermanent Resident AlienRefugeeTemporary Permanent ResidentTemporary Protected StatusTourist (b-1 Or B-2) VisaTransient F1 Student From Another SchoolUnited States CitizenVisa Student Other Than F-1 Visa Type Alien In TransitAlien In Transit To United Nations HeadquartersAmbassador, Public Minister, Diplomat & Immediate FamilyAttend, Servant, A1/A2Attendant, Servant Or Personal Employee Of G1, G2 Or G4Child Of An Alien Parent Accorded Special Immigrant StatusChild Of Fiance Or Fiancee Of Us CitizenChild Of K-3 (life Act)Child Of U1Child Of V1Child Of Victim Of Severe Trafficking In PersonsCombined Transit And CrewmanCrewmember Deaprting By Means Other Than Vessel Of ArrivCrewmember Deprting On Same Vessel Of ArrivalCulturally Unique Artists And EntertainersExchange Student VistorExecutive, ManagerialFamily Members Of O1 And O2 AliensFamily Members Of P1, P2 Or P3 AliensFiancee/Fiance Of Us CitizenForeign Govt Official & Immediate Family In TransitIncludes Principal Permanent Rep Of A Nato State & Other RepInformant Of Criminal Organization InformationInformant Of Terrorism InformationInternational Organization Officer/Employee & Immediate FamiInternationally Recognized Enterntainers And AthletesIntuernational Cultural Exchange VisitorIrish Peace Process Cultural And Training (walsh Visa)Nafta Professional From Canada & MexicoOther Foreign Govt Official Or Employees & Immediate FamilyOther Rep Of Recognized Foreign Member Govt & Immediate FamiPareint Of U1, U1 Under 21Parent Of An Alien Child Accorded Special Immigrant StatusParent Of Victim Of Severe Trafficking In PersonsPrincipal Resident Rep Of Recognized Foreign Member GovtReciporcal Exchange Artists And EntertainersReligous WorkerRep Of Foreign Media, Spouse And ChildrenRep Of Nonrecognized Or Nonmember Foreign Govt & Immed FamilSpecialized KnowledgeSpouse Of An Lpr Who Is Principal BeneficiarySpouse Of U1Spouse Of Us Citizen (life Act)Spouse Of Victim Of Severe Trafficking In PersonsSpouse Or Child Accompanying TnSpouse Or Child Of Alien Classified As H1, H2, Or H3Spouse Or Child Of Alien Classified As L1Spouse Or Child Of Exchange J1 VistorSpouse Or Child Of Q2Spouse Or Child Of R1Spouse Or Child Of Student In Academic Or Language ProgramSpouse Or Child Of Student In Vocational/Nonacademic SchoolStudent In Academic Or Language Program With Ins Form 1-20Student In Vocational Or Other Recognized Nonacademic SchoolTemporary Agriculture WorkerTemporary Protected StatusTemporary Visitor For BusinessTemporary Visitor For PleasureTemporary Worker In A Speciality OccupationTemporary Worker Nurses Work For Up To 3 Years In ShortageTemporary Worker Performing Nonagriculture ServicesTemporary Worker Performing Professional Nursing ServicesThe Derivative Child Of V1 Or V2TraineeTransient F1 From Another SchoolTransit Without VisaTreaty Investor, Spouse And ChildrenTreaty Trader, Spouse And ChildrenVictim Of Certain Crime ActivityVictim Of Severe Form Of Trafficking In PersonsVictims Of Certain CrimesWorkers Of Extraordinary Ability In Sciences, Arts, Educ,etcWorkers Who Accompany And Assist O1 Aliens Visa Issue Date  mm/dd/yyyy Visa Expiration Date  mm/dd/yyyy