Library Distance Learning Registration Form

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number (Day) Phone Number (Day) - ### - ### ####
Phone Number (Evening) Phone Number (Evening) - ### - ### ####
Fax Number Fax Number - ### - ### ####
Tarleton Email Address

In accordance with University policy, all Library notifications will be sent to your official university issued email address. For information about your student email account, go to http://www.tarleton.edu/technology/students/email.html
Academic Information
Tarleton NTNET ID#
Academic Major
Status
Instruction Site
Semester
Your course name(s), course number(s), and Instructor(s):