Register for Adult Re-entry Workshops

First Name	*
Last Name	*
Email	*
Confirm Email	*
Phone	* (10 numbers only: 123-555-6666)
ZIP	*
Major:	*
California Community College:
California State University:
University of California:
Private University:
Other Campus
Campus City
Have you already applied to CSULB?
Term Planning to Attend	*
Gender	*
Ethnicity	(optional)

Please choose a Workshop	Wednesday, June 13, 2012 - 6:00 pm (14 spots available)