Registration: Critical Pedagogy & Sustainability Certificate
Register for college credit
First Name *
Middle Name
Last Name *
Current Mailing Address
Street Address *
State *
Zip Code *
Country *
City *
Phone Numbers
Home *
Work *
Cell *
Personal Information
Email *
Date of Birth *
MM
/
DD
/
YYYY
Gender (Male/Female) *
Previous ASU Student? *
Social Security Number (with no dashes) *
Ethnicity Information
*
Required
The following Selective Service question must be answered to comply with the Colorado State Law:
Selective Service
Please Select the highest degree that you have been awarded (Bachelors Degree required to take courses for Graduate Credit) *
Required
Please Select the course(s) you would like to register for (NOTE: registration for more than one semester may be open at any given time)
Course Selection *
Required
Statement of Certification
By selecting that you agree, you are certifying that you are the person who has completed the information furnished on all sections of this application. You are certifying that to the best of your knowledge, the information furnished is true and complete. You understand that if found to be otherwise, it is sufficient cause for delay of admission, loss of credit, rejection or dismissal. You also understand that by enrolling in courses at Adams State University you are subject to all academic policies as they relate to your enrollment including but not limited to the Academic Integrity Policy 100-03-01. For more information regarding Academic Integrity, please go to http://www.adams.edu/extended_studies/undergrad/academic-integrity.php *I understand that by submitting this information via electronic transmission that I acknowledge the above in lieu of a signature*
Consent *
Required
Note
By completing registration for this semester I am entering into a legal binding contract with Adams State University (ASU) to pay all tuition, fees and related expenses, including late fees. I accept full financial responsibility for each registered course. I authorize ASU, the Extended Studies department, and their respective agents and contractors to contact me regarding my loan, student account or any balance owed to ASU at the current or any future number either provided or acquired for my cellular phone or other wireless device using automated telephone dialing equipment or artificial or pre-recorded voice or text messages. Past due balances are subject to placement with a collection agency. I agree to reimburse ASU the fees of any collection agency, which may be based on a percentage of debt up to 40%, and all costs and expenses, including reasonable attorney's fees ASU may incur in such collection efforts in accordance with Colorado statutes. ASU may also certify to the Colorado Department of Revenue my name, social security number, amount of debt, and other identifying information required by the Department for collection of my debt from the tax rebate amounts owed to me, if any. C.R.S §23-5-115..
Payment
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms