Form A2339 – Fill Out and Use This PDF

C/V

The California State University

Application for Intrasystem Concurrent or Visitor Enrollment

(See instructions on back)

This application is to be used by California State University students who wish to enroll concurrently at another CSU campus.

PART

I. TO BE COMPLETED BY STUDENT

(A) 1.

Home campus

2.

Proposed host campus

3.

Semester/Quarter of enrollment: Home

Host

4.

Home campus file #

5.

Have you previously attended the proposed host campus? Yes (

)

No ( )

If yes, what was the last term of attendance? (term/year)

6.	Legal name
			Last	First		Middle		Maiden
7.	Social Security #			8.		Date of birth
							Month	Day	Year

9.Mailing address

Street #

City

State

Zip

10a.

Home telephone # (

)

10b.

Message telephone #

(

)

10c. FAX # (

)

10d.

E-Mail

11.

Class level at time of planned enrollment:

Freshman

Sophomore

Junior

Senior

Graduate

Postbaccalaureate

12.

Major field

and/or credential objective

13.

Are you receiving financial aid?

Yes

(

No

)

(

)

(B)Listing of course(s) planned at host campus: (If a planned course(s) is a major requirement at the home campus, approval of the Department Chair at the home campus is required.) Use additional sheet if necessary.

Courses at Host Campus	Units			Units		Dept. Chairman
(Use additional sheet if necessary)	Q S		Equivalent Courses at Home Campus	Q S		Approval

No. of units planned at home campus

I certify that the information I have entered above is true and that I have read and understand the eligibility requirements, enrollment conditions and

procedures as stated. Student's Signature

Date

PART II. TO BE COMPLETED BY HOME CAMPUS

Residence status for fee purpose

Resident

Nonresident

Fee Payment Certification

County of residence

with code of

International (Visa) student at time of enrollment:

No

Yes

Maximum total units approved

REGISTRAR'S CERTIFICATION: I certify that this student's residence and academic status are correct according to the official records of this campus, that the student is eligible as of this date to register as

a continuing student, that the student qualifies for temporary transfer in accordance with Section 40808 Campus Seal or Stamp or 41030 of Title 5, that the student has complied with pertinent health-related requirements, and that this

institution approves this request for temporary enrollment for one term only.

Signature

Date

Title

Home Campus

PART III. TO BE COMPLETED BY HOST CAMPUS

A.

Approval for enrollment at host campus: Granted

Denied

Date

Fee Payment/Nonresident Tuition Certification

Remarks

Signature

Title

B.

The student registered: Date

No. of Units

Signature

Title

Campus Seal or Stamp

Host Campus

A2339/6-02

C/V

The California State University

Policies and Procedures for Intrasystem Concurrent or Visitor Enrollment

Eligibility Requirements

Undergraduate

1.Student has completed at least one term at the home campus as a matriculated student and earned at least 12 units there.

2.Student has attained a grade point average of 2.0 in all work completed at the home campus and is in good standing at that campus.

Graduate

1.The student has completed at least one term at the home campus as a matriculated student or will be enrolled concurrently in such status.

2.The student has been admitted to or is enrolled in an authorized graduate program at the home campus.

3.The student was in good standing at the last college attended.

Enrollment Conditions

1.Approval of concurrent enrollment is valid only for the term specified and is subject to space availability and registration priority policies at host campus.

2.Academic advisement is available only at the home campus.

3.Concurrent enrollment is possible only in overlapping terms.

4.Evidence of completion of course prerequisites may be required at the host campus (i.e., personal transcripts or grade reports).

5.Financial aid is available only through the home campus and students eligible for veterans, rehabilitation, social security and other federal, state or county benefits must secure eligibility certification through the home campus.

6.Health services on host campus will be limited to treatment for emergencies.

7.Participation in student activities at the host campus is subject to any limitations, which may exist at that campus. Similarly, student union facilities will be available according to policies at each campus.

8.Parking on the host campus will be available on the basis of a term fee within campus parking availability or on a daily fee basis.

9.Information concerning host campus identification card policies will be provided at registration.

Procedures

1.Student completes application and submits all five copies to the Office of Admission & Records at home campus at least four weeks in advance of the first day of classes at both campuses.

2.Home campus registrar completes Part II and forwards copies to host campus registrar if approved, or returns to student, if disapproved.

3.Host campus registrar completes Part III-A and mails a copy to student with registration instructions.

4.Student pays CSU registration fees on home campus based upon the total number of units for which she/he is or plans to be registered including units on the home as well as host campus(es), e.g. three units at host and three units at host equals part time fees, and six units at home and 3 units at host equals full time fees . Payment is certified on all copies of the application. Home campus non-resident tuition fees, as appropriate, are paid at the same time and entry made with the fee certification. Home campus retains a copy and delivers copies to student.

5.Student registers at host campus presenting certified copies of the application. Host campus non-resident tuition fees and any user fees are paid and entry is made on the copies.

6.Host campus completes Part III-B on all copies, gives one copy to student, sends one copy to home campus and retains one copy.

7.Program changes will be accomplished by following standard procedures on both campuses. Official notification will be provided by the host campus to the home campus. If a student withdraws from the home campus and requests refund for the refundable portion of the State University fee, the host campus must be notified.

8.Permanent academic records will be maintained at the campus where courses are completed. A record of credit earned at a host campus will be sent to the student and to the home campus.

A2339/6-02