___________
California Community College, degree name, major name, and term/year in
which the Associate Degree for Transfer (AA T/AS T) will be earned:
VERIFICATION OF INTENT TO EARN
ASSOCIATE OF ARTS/SCIENCE DEGREE - TRANSFER
1
Print all information legibly.
Student Name
2
:
Last First M.I.
Student ID#:
Community College ID#
Month/Day of Birth:
mm/dd
Mailing Address:
No. Street Apt.
City State Zip Code
Email Address Primary Phone Number
Student Signature
3
: Date:
1. Information regarding completion of qualifying AA-T/AS-T will be considered self-reported until verified by a community college transcript
documenting completion of degree.
2. Legal name under which a student applied to a CSU campus should be listed.
3. Your signature indicates that you have applied for admission to one or more CSU campuses with the intent to earn an AA-T /AS-T
Associate Degree in Transfer at a California Community College prior to CSU enrollment.
Following completion of your AA-T/AS-T degree evaluation, submit a copy of this form to the admissions
office at each CSU campus to which you have applied. Forms should be submitted Attn: Admissions.
For CSU campus addresses, please visit https://www2.calstate.edu/apply/Pages/contact-a-campus.aspx.
Community College Use Only:
For verifications not submitted via the ADT eVerify database.
- -
California Community College Degree/Major Name Term /Year
Courses required for the degree will be completed: Year:
Fall Winter Spring Summer
By signing this form, the official at the community college at which the student intends to earn the AA-T/AS-T
degree is verifying that the student has completed more than half of the graduation requirements for the degree
and could complete the degree within the remaining standard academic terms prior to transfer.
Title:
Evaluator Signature: Date:
Evaluator Printed Name:
CSU Use Only:
Received Campus ID:
September 2018
