1. Optional Information What race/ethnicity do you consider yourself? Check all that apply. Please specify if you indicate “Other.”
        2. Registration Information:
        Extended Education & Summer Programs

        Professional Certification

        Registration   2008-09
                 		 

        Fall 2008
        Required Information      
        Name: Please print      (Last, First, M.)     Previous Name: WWU Student #:
                
        Mailing Address: City: State: Zip:
                


                      		  
        Day Phone: Home Phone: E-mail Address:
         
                 		    
        Female

         

        Male         		Date of Birth: M/D/Y Social Security # (optional):
        Previous application or attendance at WWU? Are you currently a Washington State resident? Check one: U.S. citizen U.S. permanent resident

                              Non U.S. resident Other
         


        No


        Yes, Quarter ______ Year _______

                                    		 


        No


        Yes, from: ______ to _____

                                   Mo/Yr Mo/Yr          		If you are not a U.S. citizen and live in the U.S., list Resident Alien number or country and U.S. visa type along with date granted:

         


         



        Optional Information What race/ethnicity do you consider yourself? Check all that apply. Please specify if you indicate “Other.”
         
        Asian American:

        ¨ Asian Indian (4A/600)

        ¨ Cambodian (4C/604)

        ¨ Chinese (4C/605)

        ¨ Filipino (4K/608)

        ¨ Japanese (4J/611)

        ¨ Korean (4K/612)

        ¨ Vietnamese (4V/619)

        ¨ Thai (4T/618)

        ¨ Laotian (4L/613)         		Pacific Islander:

        ¨ Native Guamanian (660)

        ¨ Hawaiian (4H/653)

        ¨ Samoan (4S/655)

        ¨ Other: ________________

                  		Hispanic or Latino origin:

        ¨ Mexican/Mexican American/

        Chicano (3M/722)

        ¨ Cuban (3C/709)

        ¨ Puerto Rican (3P/727)

        ¨ Other: ____________________

                  		 

        ¨ Black/African American (2/870)

        ¨ Caucasian or White (1/800/999)

        ¨ Aleut (5A/941)

        ¨ Inuit (SE/935)

        ¨ Multi-racial: ___________________

         
         ¨ Native American (5N/597)

        Tribe: ____________________

        Are you an enrolled member?

                  ¨ Yes ¨ No         		  


         

         



        Registration Information:
         
        CRN

         
        Subject

        (Prefix)
        Course

        Number
        Credits
        Course Title/Instructor
        Tuition

        $50/credit
         
         


        44196
         

        EDUC
         

        451
         

        3
         

        Pre-Assessment Seminar

         
         

        $150
         
        All courses taken for credit in Professional Certification use the designated S/U grading mode .


         

        X __________________________________________________________________________________________

        Student Signature Date

         

        *YOU ARE INCURRING A LEGAL DEBT! I understand that by submitting this form, I am incurring a legal debt to WWU and will not be released from that debt unless I follow required schedule change procedures and deadlines. Should I decide to withdraw from this course, I must request refunds in writing EESPRegistration@wwu.edu prior to the 2nd class meeting.    It is my responsibility to obtain information regarding University registration/withdrawal policy.

         

        PAYMENT INFORMATION (U.S. Funds Only)! Payment must be included at time of registration. WWU/EESP will send you a receipt upon receiving a completed registration form and tuition payment.   The registration deadline is November 1, 2008.

         





         

         

         

         

         

         

         

         

         

         

         

         

         


        Western Washington University t (360) 650-3308

        Extended Education and Summer Programs

        516 High Street t Mail Stop 5293 t Bellingham, WA 98225

        CONFIDENTIAL FAX : (360) 788-0854 (registrations with credit card payments only)



        Registration Instructions

         


        A registration form (pdf version) has been attached.

         

        Fill in all the information, sign and date the form and return with payment to Extended Education & Summer Programs. If payment is not submitted at the time of registration or the form is not signed and dated it can not be processed. Acceptable payments methods are: agency purchase orders, money order, check, and Visa or Master Card. If paying by credit card please make sure that all blanks, including both places for signature are filled out legibly in the appropriate boxes.

         

        Mail the form to:    EESP

             516 High Street, MS 5293

             Bellingham, WA 98225-5996

         

        Or fax it to our confidential fax at: 360-788-0854

         

        Should you decide not to obtain credit after you have registered you must formally withdraw from the class before the end of the term. To receive a refund you must withdraw before the second class meeting. To withdraw email EESPRegistration@wwu.edu.

         

        At the end of the course you may access your grade report following the directions below.

         

        To obtain a transcript call 360-650-3355 or visit http://www.wwu.edu/depts/registrar/transcripts.shtml for instructions.

         

         

        Grade reports: WWU does not mail grade reports to students at the end of the quarter. You will need your WWU Student ID # to access this information from WWU’s website. If you obtain a billing statement for tuition the ID# appears on that statement. It begins with a W and is followed by eight numbers; i.e., W12345678. This number is the only way to access your records at Western Washington University

         

        If you pay by credit card or purchase order and therefore do not receive a billing statement and do not know your WWU Student ID #, please call the Registrar’s Office at 360-650-3432. They will ask you for your name, including middle initial; social security #, and birth date to look up your WWU ID#.

         

        To view your academic record on the web:
        1. Work prior to Fall 1984 will not be on the Web.
        2. Use mouse to move from field to field, not Enter/Return (this will automatically exit)
        3. Go to www.wwu.edu/web4u
        4. Enter WWU ID#, (make sure W is capitalized), e.g. W12345678 Enter six digit PIN, which is one of the following: the first six digits of the student’s Social Security # . Or if you are a Canadian Citizen your birth date in six digit format. If neither of these work call 360-650-3432. Instructions are available for changing your PIN see instructions under NOTE.
        5. Click on “Student Services & Financial Aid”
        6. Click on “Student Records”
        7. Click on “Academic History” If you have a money hold, you will not be able to view academic history and will need to view the “Final Grades” option. If you need a printed copy of your grades reflecting your name, the “Academic History: is the option you should choose.
         


        NOTE: These records are for the student’s use only. For use in employment or other academic institutions, these copies will not be accepted. i.e., WWU Placement Office will not accept these copies. Also note that there is an option to change pin. Instead of clicking on student “Student Records” click on the “Personal Information” option.

         

        Choose 4—Grading information

        Choose 1—Review Grades

        Enter your student number—This is your nine-digit student number that begins with a W.

         

        If you can not gain access to the web—use the following phone number. Dial 360 650-3333.

         

        If you have any questions please call Student & Course Services at 360-650-3308.

         

        Back to top