PCC ID#: _______________ SEVIS ID#: N00___________________
Program End Date on I-20: _________ Passport Expir on Date: _________ Visa Expir on Date: _________
mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy
(last 8 digits)
__________________
___________________________________________________________ _______________________________________
___________________________________ __________________________________ ________________________
Concurrent Enrollment Request Form
Student to complete:
Student Name:
______________________ ______________________ _________
First
Family Name MI
Date of Birth:
___________
Phone#:
_______________
mm/dd/yyyy
PCC Email
:
____________
@go.pasadena.edu
Major:
________________ First Semester at PCC: ___________ Expected Gradu on: ___________
mm/dd/yyyy mm/dd/yyyy
Fall
______
____________________________________________
Term :
Spring
Full name of school you would like to a end
Year
Concurrent enrollment is defined as aending PCC and another SEVIS-approved insituon at the same me. To request concurrent
enrollment, this form must be signed by the Academic Counselor prior to ISC authorizaon. If you enroll in 12 units at PCC or take
a class at another insion dring Summer or Winter session, you do not need the Academic Counselors signature. If the ISC
approves your request, an authroizaon leer will be given to you to present to the school you wold like to enroll in.
STEP 1: You must enroll in at least 6 units at PCC and obtain a signature from an Academic Counselor first.
STEP 2: Submit the Concurrent Enrollment Request Form to ISC.
STEP 3: Submit a copy of unofficial transcript from the school you ended under concurrent enrollment to ISC within one week
a er your registr on.
STEP 4: Upon comple on of the course(s), you must submit 1) a copy of unofficial transcript including your final grade(s) to ISC
and 2) an official transcript to Admissions & Records Office within 1 week a er grades are posted.
I have read and understood the informa on above and my responsibili es. I state that the informa on I provided on this form is true.
Student Signature mm/dd/yyyy
Academic Counselor to Complete (if you have less than 12 units at PCC)
____________________________
PCC Course # and Title Units
Equivalent CRN
Title Units
______________________________
______________________________
______________________________ _______
_________________ _________
PCC is not offering the course during Fall/Spring semesters.
The course(s) the student needs is closed.
Student’s repeat pe on was denied and s/he must take the course at another college.
Academic Counselor Signature Printed Name mm/dd/yyyy
ISC staff to complete:
SEVIS SARS Request log
Unit # _____
Notes in “Drop Below Full Time Comments” in GOASEVS
Le
er issued
E
mail A&R Email student
Google Form
Ini al: ______ Date:
_______
Important Note: All paperwork requests require 10 business days to process. revised 4/25/2018
