Fillable Concurrentenrollmenteform042415

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Concurrentenrollmenteform042415

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COLUMBIA COLLEGE / MODESTO JUNIOR COLLEGE
CONCURRENT ENROLLMENT FOR CONTINUING STUDENTS
Date : _________________ College Currently Attending: (Select One) Columbia Modesto
Student Name:_________________________ Student ID#: ___________ Birth Date:______________
Contact Number: ____________________ Student Signature: ______________________________________
Desired Class(es): ___________________________________________________________________________
Are prerequisites required for desired class/classes?
Yes No (If NO, transcripts will not be evaluated)
Term/Year of Intent (Select One): Summer _________ Fall __________ Spring _________
Send To: Send To:
Columbia College Modesto Junior College
Admissions and Records Oce Enrollment Services Oce
11600 Columbia College Dr Sonora CA 95370 435 College Ave Modesto CA 95350
E-mail: ccadmissions@yosemite.edu E-mail: MJCESeforms@mjc.edu
Fax: 209-588-5337 Phone: 209-588-5231 Fax: 209-575-6859 Phone: 209-575-6853
OFFICE USE ONLY
High School Sudent: Yes _____ No _____ Local Units Earned & Currently Enrolled in: ____________
Appointment For: Summer __________ Fall __________ Spring _________
Orientation: ______________ Testing: ______________ Eduational Plan: _____________
Appointment Date: ________________ Appointment Time: ______________ Level: ______________
Initials: _____________ Online Date: ____________ Matriculation Met: ____________
Notes:
Rev 4/24/15
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Concurrentenrollmenteform042415

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Completed 11 March 2020

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