1. Student's ID Number:
2. Student's Name:
3. New Student: Admitted to Continuing Student
4. Graduate Student Credential Student
5. If a new student, list most recently attended college or university. Please indicate enrollment period. Example: Alpha College (mm/yyyy to mm/yyyy):
from ( / ) to / )
6. Will the student receive any of the following scholarships or other assistance?
7. If the student is receiving any of the scholarship/tuition assistance listed above, please indicate the dollar amount per term:
8. Number of units student will be taking beginning in fall 2012 and ending summer 2013:
9. Will this student complete his or her academic program prior to Fall 2013?
11. Completed by at the Campus.