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Request for Course Registration
(For part-time/EWG 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:
   
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 EWG homepage as well as the the course catalog. Clicking on either of these two links will open a new window within your browser.
Dept/Course#/Sec Course Title Day(s) Time Credit Term Campus

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.