FA15 Self Pay Enrollment form.doc - ctri ucsd 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and selecting your title (MS, MR, DR, MISS, MRS).
3. Provide your SS# or UCSD Extension Student PID# if applicable, along with your email address.
4. Fill in your position/title, department, UCSD mail code, and both work and home/cell phone numbers.
5. Complete the work and home address sections accurately, ensuring all fields are filled out.
6. Select your discount fee category by checking the appropriate box for UCSD Staff, Fellow, or Faculty.
7. Choose a payment method by checking either Personal Check or Credit Card. If using a card, enter the number and expiration date.
8. Indicate the courses you wish to enroll in by circling the corresponding discounted fees and class dates.
9. Finally, submit the completed form along with payment details to UCSD Extension Student Services as instructed.

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