**All fields are required and must be completed in order to subit this form**

Name (Last, First, MI):

Address:

City/State/ZIP:

Social Security Number:

Area of Study:

Home Phone:

Indicate the day you plan to attend: April 28       April 29       June 10

Please indicate the approximate time you plan to arrive: between
the hours of 8:30 a.m. to 12:00 AND 1:00 to 3:30 p.m.

Payment is a $30 non-refundable registration & orientation fee
Payment Enclosed: Mastercard VISA Discover American Express
(If you are paying by check, please send payment to FHSU, Student Affairs Office, 600 Park St., Hays, KS 67601-4099)

Credit Card Number Expiration Date
(Please enter 16 digit credit card number)

Name as printed on credit card

Questions about Tiger Enrollment? Call the Office of Student Affairs at (785) 628-5824 between
8 a.m. and 4:30 p.m. weekdays, or e-mail enrollment@fhsu.edu.