Request a Course Registration Form

Public Request a Course Form

Name(Required)

First Last

Preferred Email Address(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone Number(Required)

First course you're requesting: Course title & CRN #(Required)

Next course you're requesting: Course title & CRN #

Prior attendance at any University of Maine System campus?

Yes

Are you a veteran?

Yes

Date of birth (Necessary for Immunization Law purposes)(Required)

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