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Alumni Professional Learning Registration Form

Please complete and submit the form below. The registration process is not complete until final payment is received. For additional assistance, please contact Christopher Graham at

Title: (Dr., Mr., Mrs., etc.)
First Name*:
Middle Initial:
Last Name*:
Degree received from Regent: Which School

Graduation Year
Home Address:
Home Phone:
Cell Phone:
Place of Employment:
Job Title:
Work Address:

Please fill out the following information. It is required as a matter of legal reporting requirements applicable to Regent University. It will not be taken into account in any admission or academic decision, nor in the administration of any program at the university.

Date of Birth:
Ethnic Origin:

Tuition & Fees:

  • Professional Learning Tuition is $1000* per course

*Includes tuition and infrastructure fee. University fees and books are not included.


Submitting this form indicates that I am agreeing to be registered for the following listed courses and that I take full financial responsibility unless a written request to withdraw is granted by the dean.

Note: Regent University reserves the right to change or cancel courses. Please call or visit our website to confirm the location, date and time of your course prior to the first day of class.

Spring 2013 Semester

Course Number & Title:
Course Number & Title:



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