Please complete one form per course with a unit value. Required fields are marked with an asterisk (*).

IMPORTANT ENROLLMENT DATES: Concurrent Enrollment Academic Calendar

Information must be entered within 20 minutes. Otherwise it will be necessary to login again and re-enter information.

* indicates required field

Student Information

In order to assess our community outreach efforts, we ask our students to complete the following information. Providing the information is strictly voluntary and is requested for statistical purposes only.
Address Information
Phone Information

*While only one phone number is required, multiple numbers will allow us to more easily contact you to resolve any issues with your application. Please include your work extension if applicable. Any phone numbers you provide us will be used solely in relation to your program application. You will not be contacted by UCI Division of Continuing Education for marketing purposes.


General Information