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Dept/Course#/Sec

Course Title

Request for Course Registration
(For part-time/DAL students only. If you wish to become a full-time student, please visit our Admissions site for more information.)

Simpson ID/
Last 4 digits of SSN:

Gender:

Male Female

Birthdate:

First Name: *

Middle Name:

Last Name *

Address *

City:

State

Zip/Postal Code:

E-mail Address: *

Contact Phone: *

Best time to call:

Day Night

Employer:

High School
Graduation Date:

Reason for attending Simpson:

B.A. Degree - Intended Major:
Master of Arts in Teaching
Certificate Candidate:
Transfer Credit to Another College:
Other:

Prior College Experience
(for transfer credit):

The information to fill out the fields below can be found on the course search page or course lists on the DAL homepage as well as the the course catalog. Clicking on either of these two links will open a new window within your browser.

We will contact you promptly to confirm your registration. Due to the possibility that the course may be full, completion of this form does not guarantee enrollment.