Dr. Kirshner's Western Civilization Self-Paced Registration Form
COURSE: History 104A Self-Paced History 104B Self-Paced
NAME:
E-MAIL:
COUNTRY OF ORIGIN: IF USA, STATE OF ORIGIN:
HIGH SCHOOL ATTENDED: YEAR OF GRADUATION:
IF STILL IN HIGH SCHOOL, GRADE:
OTHER COLLEGES ATTENDED: GPA:
OTHER COLLEGE HISTORY COURSES YOU HAVE COMPLETED:
WHY ARE YOU TAKING THIS COURSE?:
ANY OTHER COMMENTS: