Class Registration for Non-Matriculated Students

For non-matriculated students. We need this information for our records, and so we can send you login instructions for the online classroom. We do not sell, lend or barter your information to any other organization or agency.

Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email *
Home Phone * - (###) - ### ####
Mobil Phone - (###) - ### ####
Date of Birth * / MM / DD YYYY
Highest level of education completed. List school and degree. *
Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the ethnic/racial
backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions.
Do you consider yourself to be of Hispanic / Latino / Spanish
origin?
* Yes No
Please also select one or more of these racial categories to describe yourself. American Indian Alaska Native Asian Black African American Native Hawaiian Pacific Islander Caucasian
I hereby certify that the above information provided by me is true and correct. I understand that if I misrepresent information or provide untruthful information, it can result in my acceptance to the Cherry Hill Seminary being declared null and void. I agree to abide by the rules and procedures of Cherry Hill Seminary. * Yes No
Signature and date *