Online Registration Form


Please make sure to supply information in all required fields (bold text).

Quarter, Year (e.g., Spring, 2012)
If the course is on campus, please add a "C" after the course number if online add an "L", e.g., PSY501C or PSY501L. Thank you.
Course #1
Course #2
Course #3
Course #4
Course #5
Student Information
First Name
Last Name
Work Phone
?
Please enter your work phone number, including the country code if you are outside the United States.
Home or Mobile Phone
?
Please enter your home or mobile phone number, including the country code if you are outside the United States.
Email
Address 1
?
Please enter the street address and street name on file for the form of payment you are using below.
Address 2
City
?
Please fill in the city of the address on file for the form of payment you are using below.
State
?
Please fill in the state of the address on file for the form of payment you are using below.
Zip Code
Country
Credit Card Information
Card Type (Master Card or Visa)
Name on Card
Card Number
Expiration Date
Amount $
For tuition fees, please visit: https://www.cihs.edu/wordpress/index.php/admissions/tuition-fees/
For more information, please contact us by phone at (760) 634-1771 or via email at admin@cihs.edu
If there is anything else you would like to tell us, please use the form below.
Please type the letters you see in the box in the field below the box.
Please type the letters you see in the box in the field below the box.
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