COSUMNES RIVER COLLEGE
VETERAN’S SERVICES CONSORTIUM REQUEST
FORM 2019-2020
NAME:________________________________________, ______________________________ ID#: _________________
Last First
DEADLINE TO FILE FOR CONSORTIUM:
Summer/Fall: 1
st
Monday of June Spring: 1
st
Monday of January
A consortium may be granted when the class(es) required toward completion of the students educational goal (certificate, graduation, and
transfer) that is not offered at CRC or the class(es) offered at CRC conflict with the student’s class or work schedule.
Select Term (circle one) Fall __________ Spring __________ Summer ________
Year Year Year
Briefly describe the reason(s) why you are not able to take the course(s) at CRC (if applicable, attach supporting documentation):
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
CERTIFICATION
I understand the only the course(s) required toward my educational objective will be considered and is approved by my academic
counselor (counselor signature is required below). If I am no longer enrolled in the approved courses listed on my consortium at the time
of review, the request will be null and void. I also understand that it is my responsibility to obtain course descriptions, outlines,
transcripts, and other documents as needed to determine acceptance of the course(s) of the degree granting institution.
Student Signature:_________________________________________________ Date: ______________________
Counselors agrees that course(s) listed below are necessary for a certificate, graduation, or transfer:
_____________________________________________________________________________________________________________
Counselor’s Name (Please Print) Counselor’s Signature Date
DO NOT WRITE BELOW THIS LINE
Consortium GRANTED with ARC / FLC / SCC / OTHER Term: Fall / Spring / Summer
Consortium POSTPONED Date:__________________ Pending:_______________________
Consortium DENIED
Accredited: Y / N
If NO, list accreditation : __________________________________________________________________________
________________________________________________________________________________________________________
Veteran’s Certifying Official’s Signature Date
(Revised 6/2015)
Once the forms are completed, students may send from their Los Rios email account to: YangJ@crc.losrios.edu for processing.
