U Application For Cross Enrollment To The California Community Colleges Or The University Of California printable pdf download

U Application For Cross Enrollment To The California Community Colleges Or The University Of California

CSU

Application for Cross Enrollment

to the California Community Colleges or the University of California

Complete form and submit to office of the registrar or other designated cross enrollment office at your home campus prior

to the host campus filing period. You must verify admission and filing deadlines with the host campus. After home

campus completes certifications, seek instructor approval at host campus during filing period designated by host campus.

Host campus will provide registration instructions.

Home Campus __________________________________

Host Campus ____________________________________

Planned semester/quarter/term of cross enrollment:

Term__________________

Year___________________

If you have previously attended the host campus, what was last term attended? _________________________________

Name ________________________________________________________

Last four digits of your Soc. Sec. # _____

Last

First

Middle

Mailing Address: ________________________________________________

Home Campus ID# _________________

________________________________________________

Birthdate

_______/_______/_______

Home Telephone (

) ___________________________

Message Telephone (

) ________________________

Reason for taking course:

Course unavailable at home institution ____

General interest in subject _____

Completing transfer _____

Other __________________________________________

I certify the information provided is accurate and that I have read and understand eligibility requirements, enrollment

conditions, and procedures as stated.

Date _____________________________ Signature ______________________________________________________

-------------------------------------------------------------------------

HOME CAMPUS CERTIFICATION

_________________________________ certifies that this student meets cross enrollment eligibility requirements.

Home campus name/code

Signature

Title/Seal

Date

-------------------------------------------------------------------------

HOST CAMPUS CERTIFICATIONS

Approval of class instructor:

Course planned at

Units

Instructor

host campus

Approval

Processing fee received _____________________________

Cross enrollment approved ________ Date _____________

Signature ___________________________________

(Please see page 2 for additional information/requirements)

U Application For Cross Enrollment To The California Community Colleges Or The University Of California

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