Special Student Registration Form - Evergreen State College

Have you previously attended classes at Evergreen?
No
Yes, last quarter attended:
Mailing
Address City State Zip
Phone ( ) Alt. # ( ) E-Mail
Social Security Number Date of Birth Sex:
Male
Female
Are you a U.S. Citizen?
Yes WA Resident:
Yes Resident Since (MM/YY):
No Nationality:
No
Are you Hispanic in origin?
Yes, I am Hispanic in Origin. (Select one or more): (H10)
No, I am non-Hispanic in origin. (H20)
Colombian (707)
Costa Rican (708)
Cuban (709)
Dominican (710)
Ecuatorian (Ecuadorian) (711)
Guatemalan (716)
Honduran (718)
Mexican or Mexican-
American (Chicano) (722)
Nicaraguan (723)
Panamanian (724)
Peruvian (726)
Puerto Rican (727)
Salvadoran (712)
Spanish (730)
Uraguayan (734) Venezuelan (735)
Other Hispanic Origin (H10):
How do you describe your race? (Select one or more):
American Indian (Select one or more):
Chehalis (020)
Chinook (055)
Colville (159)
Cowlitz (027)
Duwamish (031)
Hoh (052)
Jamestown (023)
Kalispel (156)
Kikillus (032)
Lower Elwha (024)
Lummi (028)
Makah (053)
Muckleshoot (034)
Nisqually (035)
Nooksack (029)
Port Gamble Klallam (025)
Puyallup (036)
Quileute (051)
Quinault (050)
Samish (037)
Sauik-Suiattle (038)
Shoalwater (492)
Skokomish (079)
Snohomish (041)
Snoqualmie (042)
Spokane (160)
Squaxin Island (043)
Steilacoom (044)
Stillaguamish (045)
Suquamish (045)
Swinomish (047)
Tulalip (048)
Upper Skagit (039)
Yakima (078)
Other American Indian (R13): ________________________________________
Alaska Native (Select one or more):
Alaska Aleut (Unangan) (941)
Alaska Alutiiq (942)
Alaska Athabaskan (014)
Alaska Eskimo (Inupiaq or Yupik) (935)
Alaska Eyak (943)
Alaska Haida (016)
Alaska Tlingit (017)
Alaska Tsimshian (018)
Other Alaska Native (950):
Asian (Select one or more):
Asian Indian (600)
Bangladeshi (601)
Bhutanese (602)
Burmese (603)
Cambodian (Kampuchean) (604)
Chinese (605)
Filipino (608)
Hmong (609)
Indonesian (610)
Japanese (611)
Korean (612)
Laotian (613)
Madagascar (639)
Malayan (614)
Maldivian (634)
Mongolian (624)
Nepali (635)
Pakistani (616)
Singaporean (637)
Sri Lankan (617)
Taiwanese (606) Vietnamese (619)
Thai (618) Other Asian (R20):
Black or African American (R30)
Native Hawaiian or Other Pacific Islander (Select one or more):
Fijian (676)
Guamanian (660)
Kosraean (667)
Mariana Islander (661)
Marshall Islander (662)
Micronesian (669)
Native Hawaiian (653)
Palauan (663)
Papua New Guinean (678)
Ponapean (Pohnpeian) (670)
Samoan (655)
Solomon Islander (679)
Tahitian (656)
Tarawa Islander (672)
Tokelauan (659)
Tongan (657)
Trukese (Chuukese) (674)
Vanuatuan (New Hebrides Islander) (680)
Yapese (675)
Other Pacific Islander (R40):
White (includes people of European, Middle Eastern, or North African descent) (R50)
SPECIAL STUDENT REGISTRATION FORM
FALL
WINTER
SPRING
SUMMER YEAR
Evergreen ID# A
Legal Name
Last First Middle
FOR OFFICIAL USE ONLY
NonResident
Resident
UG
GR
TOTAL
CREDITS
Late fee?
NO
YES $50 $100
Student Accounts
OK to reg?
YES
NO
Financial Aid
OK to reg?
YES
NO
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Special Student Registration Form - Evergreen State College PDF

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