RUSH-A ADVISING & REGISTRATION

First Name: Last Name:

CSUB ID #:

Address: City:

State: Zip:

Day Phone: Home Phone:

Date of Birth:

Email:

Planned Major:

CSUB Class Level: Select CSUB Class Level Freshman Sophomore Junior Senior

Please select one:

January 4, 2013 ALL NEW STUDENTS Day 8:30 a.m.

Accommodations Required: Disability Status

UNLESS EXEMPT, EPT/ELM must be taken prior to attending this program.

PROGRAM FEE: $55.00
Make check or money order payable to CSUB Advising-Registration Program.

Pay at Door