Riverside Community College District
Extra-Curricular Activities
and Honors Coursework Record
Name
Last, First
Student ID #
(Please type)
Please List:
Student Government,
Club/Organization Membership
or Service to Community
PARTICIPATION/
POSITION HELD
ADVISOR’S COMMENTS
ADVISOR’S SIGNATURE
Extra-Curricular Activities and Honors Coursework Record
TERM/ YEAR
HONORS COURSES
WERE TAKEN
COURSES TAKEN
Honors Office Use Only:
PROGRAM CERTIFICATION
Honors Office Use Only:
PROGRAM COORDINATOR’S
SIGNATURE
YEAR
PUBLICATIONS
ADVISOR’S COMMENTS
ADVISOR’S SIGNATURE
YEAR SCHOLARSHIPS/AWARDS
COLLEGE OFFICIAL’S
SIGNATURE
College Student Services Administrator
Name:
Date:
Title:
Signature:
Dean of Student Life/Services