Fillable Los Angeles Mission College (Los Angeles Mission College)

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Los Angeles Mission College (Los Angeles Mission College)

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Los Angeles Mission College
13356 Eldridge Ave, Sylmar CA 91342-3245
OFF SITE CLASS REQUEST FORM
Magaly Rojas-Gonzalez
Name of High School/Organization LA Mission College Contact Person
Dual Enrollment Coordinator
High School/Organization Contact Person Title
rojasgm@lamission.edu
Address City Email Address
818-833-3421
Email Phone
Fall Winter Spring Summer A
Phone
Summer B Year:
DATES:
LAMC Use
Only
CLASS REQUESTED
Section # COURSE NAME/# UNITS START/END TIME DAY ROOM
CLASS
LIMIT
I acknowledge that any course offered during the school day is open to the public.
Textbooks are required when enrolling in a college level course. I acknowledge that it is the responsibility of
the high school to ensure that all students have the required textbook on the first day of the class session.
Administrator’s Name (Principal or designee)
Signature
Date
LAMC APPROVAL
Dual Enrollment Coordinator or designee Signature
Date
This request form must be completed, approved and signed by the Principal (or designee) of the institution and the Dual
Enrollment Coordinator or designee, prior to an off-site class being officially scheduled.
CLEAR
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Los Angeles Mission College (Los Angeles Mission College)

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Completed 25 July 2020

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