CCV CROSS-ENROLLMENT PROGRAM
APPLICATION FOR PARTICIPATION
Student's Name: ______________ Date of Birth: ________________________
Social Security Number: _______ US Citizen: Y N Sex: M F
Permanent Home Address: ____________________________
City: _____________________________ State: _____________ Zip: ___
Home Phone Number: ______________
Local Address: _______________________________
City: _____________________________ State: _____________ Zip: ___
Local Phone Number: _______________ Email Address: __
Concentration: ____________________________ Term Standing: ____________
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Host Institution:
Course Number:
By checking this box, I agree to allow Bennington to share my contact information with other students approved for
the cross-enrollment program for the purposes of arranging carpooling.
Please attach a typed explanation as to how this particular course fits in with your Bennington academic plan.
I am familiar with the eligibility requirements of this program and understand that by signing this document I am
authorizing the release of any biographical/demographic or other pertinent academic information (including official
transcripts) which may be required for enrollment in this program.
Student Signature: __________________________ Date: ___
Advisor Signature: ______________________________ Date: _________
__________________Course Title: __________________________________________________________
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Term Course is Offered: _________________________
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Credit Hours: _____________________ Home Institution Equivalency: ______________________
Please note:
Students must earn a grade of C or above to transfer credit. Bennington College does not transfer
grades or grade points from other institutions; only credits are transferred.
APPROVALS REQUIRED (Please secure in order listed AFTER you have received approval to cross enroll.)
Dean/Registrar (Home Institution):_____________________________________________________ Date: _____________________
Course Instructor: _____________________________________________________________________ Date: _____________________
Dean/Registrar (Host Institution):______________________________________________________ Date: _____________________
For more information contact:
Bennington College Dean's Office at 802-440-4400
CCV Registrar's Office at 802-262-6559
