Center for Professional Development
Online Course Registration Form

Please click here for a printable form.

First Name:

 (required)

Middle Initial:

Last Name:

 (required)

E-mail Address:

 (required)

Street Address:

City:

State:

Zip-Code:

Home Area Code & Phone #:

Business Area Code & Phone #:

Fax Area Code & Phone #:
How did you first learn about the program? Catalog Flyer Poster Web Friend Other
Have you taken classes through SCU or our CPD Program? Yes No
If yes, what was the date of the last class you attended?
Student ID:
Why are you taking this class? CEU credits CE credits Credentials Other
Are you an alumnus of SCU? Yes No
If so, what year did you graduate from SCU?
Educational Background: BA/BS MA/MS Ph.D. Other
For Counseling Psychology Professionals Only:
What type of Clinical License do you hold? MFCC LCSW Psychologist Other
Credit Requested: Psychologist MFCC/LCSW NBCC BRN General CE hours/units
License #:
Enrollment Information
Please enter the information for the courses you would like to register for:

  Course Name (ex. CPSYx233) Date of Course (ex. 05/14/04)
1
2
3
4
5