SRCCV
C/V
The California State University
Application for Intrasystem Concurrent or Visitor Enrollment
(See instruc
tions on back page)
This application is to be used by California State University students who wish to enroll concurrently or as a visitor 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 Campus
Host Campus
4. Home campus student ID #
5. Check one & only one:
Visitor Concurrent
6. Have you previously attended the proposed host campus? Yes No
If yes, what was the last term of attendance? (term/year)
7. Legal name
Last First Middle Maiden
8. Social Security #
9. Date of birth
MM/DD/YY
10. Mailing address
Street #
City
State Zip
11a.
Home telephone # ( )
11b. Message telephone # ( )
11c. FAX # ( )
11d. E-Mail
12. Class level at time of planned enrollment:
F
reshman Sophomore Junior Senior Graduate Postbaccalaureate
13. Major field________________________________________ and/or credential objective________________________
14. 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
(Use additional sheet if necessary)
Units
Q S Equivalent Courses at Home Campus
Units
Q S
Dept. Chairman
Approval
Number 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 or
41030 of Title 5, that the student has complied with pertinent health-related requirem
ents, and that this
institution approves this request for temporary enrollment for one term only.
Campus Seal or Stamp
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
Number of Units
Signature
Title Campus Seal or Stamp
A2339/2011
Host Campus
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. Visitor enrollment will not be approved if the terms overlap
on home and host campus.
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 available at the time of registration.
Procedures
1. Student completes application and submits to the Office of Admission & Records at home campus in advance of the
first day of classes at both campuses. Contact host campus for deadlines, if any.
2. Home campus registrar designee completes Part II and forwards copies to host campus registrar designee 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. Concurrently enrolled 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 home
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.
5. Student registers at host campus presenting approved copies of the application. Host campus non-resident tuition fees
and any user fees are paid
.
6. Host campus completes Part III-B.
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 available to the student and to the home campus.
A2339/2011