COLUMBIA COLLEGE/MODESTO JUNIOR COLLEGE
CONCURRENT ENROLLMENT FORM FOR
CONTINUING STUDENTS
Today’s Date:
College Currently Attending (Select One): Columbia MJC
Student Name: Student ID:
Birthdate: Contact Number:
Desired Class(es):
Are prerequisites required for desired class(es)? Yes No*
(*If NO, transcripts will not be evaluated)
Term/Year of Intent (Select One): Fall Spring Summer
Student Signature: Date:
Send To:
Columbia College Modesto Junior College
Admissions & Records Oce Enrollment Services Oce
11600 Columbia College Dr. Sonora, CA 95370 435 College Ave. Modesto, CA 95350
Email: ccadmissions@yosemite.edu Email: MJCESeForms@mjc.edu
Fax: 209-588-5337 Phone: 209-588-5231 Fax: 209-575-6859 Phone: 209-575-6853
Concurrent Enrollment Form 5/27/2015
OFFICE USE ONLY
High School Student: Yes No Local Units Earned & Currently Enrolled in:
Orientation: Testing: Educational Plan:
Appointment For: Fall Spring Summer
Appointment Date: Appointment Time: Level:
Initials: Online Date: Matriculation Met:
Notes:
Matrix IASU PERC SREP UTEC STAC STAT
Fax Sent:
