She Rises

Registration

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She Rises Registration

Learn more about SHE RISES

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Name*

First Middle Last

Gender*

Email*

Phone*

Address*

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

Country of Citizenship*

Select Country

National Identifier*

(e.g.; US Social Security Number, National Insurance Number, or Personal Account Number)

Date of birth*

Payment

SHE RISES Course Selection*

Total SHE RISES Payment:

Credit Card

Card Details

Cardholder Name

Signatures

Transferring Credit*

I acknowledge that, if I am enrolled in another institution and intend to transfer credits from Southeastern University’s SHE RISES course, I am responsible to inquire with my home institution to ensure the credits will transfer into my current degree program.

Charges & Fees*

By checking this box, I acknowledge that I am responsible for all charges and fees once I begin participating in university coursework. Further, I acknowledge that any refunds require an official request to the university and any such requests must be submitted prior to starting coursework.

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She Rises Registration

Payment

Signatures