Fillable District Information Concurrent Enrollment Form

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District Information Concurrent Enrollment Form

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The District Information Concurrent Enrollment Form form is 2 pages long and contains:

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File type: PDF

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Name of Institution: ___
Address: __________________________________________________________
City: ________________________________ Zip Code: _________________
Fax: ____________________ Contact Name: __________________________
Contact Number: ___________________ Email Address: ___________________
Veronica Gutierrez, Admissions, Records and Services
11110 Alondra Blvd., Norwalk, CA 90650-6298 562-860-2451, Ext: 2110
Authorized Names and Signatures
Authorized names may include counselors, administrators, etc.
__________________________________ ________________________________
Head Counselor Name Signature
Authorized Signature Form
This allows Cerritos College Admissions, Records and Services
to verify signatures from designated counselors and/or admin-
istrators authorized to sign Special Admit and College Bridge
forms. Admissions, Records and Services must receive the Au-
thorized Signature form prior to any of your students concur-
rently enrolling at Cerritos College.
__________________________________ ________________________________
Print Name and Position Signature
__________________________________ ________________________________
Print Name and Position Signature
__________________________________ ________________________________
Print Name and Position Signature
__________________________________ ________________________________
Print Name and Position Signature
__________________________________ ________________________________
Print Name and Position Signature
Please mail this form to the address below, as original documents are required. FAXES
will not be accepted.
__________________________________ ________________________________
Principal Name Principal Signature
11110 Alondra Blvd. Norwalk, Ca 90650-6298 Admissions & Records (562) 860-2451 ext: 2211
Session Certification
Required for Summer only
I certify, as principal of ______________________________________, that all pupils recommended for
Summer 2010 meet all of the following criteria:
1. Each pupil demonstrates adequate preparation in the discipline to
be studied.
2. Each pupil has exhausted all opportunities to enroll in an
equivalent course at his or her school of attendance.
3. The total number of recommendations complies with the
requirement allowing only 5% of the total number of students
enrolled in the high school’s grade level to be recommended for
admission to Cerritos College.
The total student enrollment for the
Summer 2010 academic year.
9
th
grade _____________ x 5% = ___________
Total # of enrollment
10
th
grade _____________ x 5% = ___________
Total # of enrollment
11
th
grade _____________ x 5% = ___________
Total # of enrollment
12
th
grade _____________ x 5% = ___________
Total # of enrollment
_____________________________________
Principal Name (Please Print)
Cerritos College
Admissions, Records and Services
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District Information Concurrent Enrollment Form

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Completed 26 June 2020

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