800 College Avenue ~ Weed CA 96094
Phone: (530) 938-5374 ~ Fax: (530) 938-5367 ~ Email: firstname.lastname@example.org
SOUTHERN OREGON UNIVERSITY
EXCHANGE PROGRAM PERMIT REQUEST
Last Name: First Name: MI:
Date of Birth: SSN:
COS Email: Phone:
City: State: Zip Code:
This is my first request This is a request for renewal
I plan to begin at SOU in the: Fall Winter Spring Summer Year:
Number of transferable units at COS.
Completed: In Progress: GPA:
Total number of transferable units from all other institutions completed: in progress:
I request permission to participate in the exchange program between College of the Siskiyous and Southern Oregon
University. I have satisfied the eligibility requirements listed below. If granted, I am aware of the conditions of the permit as
Student Signature: Date:
1. Must be a California resident.
2. Must not have any COS registration holds.
3. Must not have a bachelor’s degree.
4. Must have completed one of the following sets of requirements:
a. Complete a minimum of 24 semester units of transfer-level course work at College of the Siskiyous with a cumulative transfer
GPA of at least 2.25.
b. Complete a minimum of 24 units of transfer-level course work and receive and complete an Associate degree from College of
the Siskiyous with a cumulative transfer GPA of at least 2.00.
Conditions of Permit
1. Issuance of this permit does not guarantee admission to Southern Oregon University. A student must file a separate application for
admission to SOU and meet SOU admission requirements.
2. This permit may be used for undergraduate work only.
3. This permit will remain in effect for the academic year as requested and will be automatically renewed if the following conditions
a. Student remains in good standing at SOU;
b. Student follows prescribed course of study at SOU;
c. Exchange agreement between College of the Siskiyous and Southern Oregon University remains in effect.
4. Any time spent at Southern Oregon University under the auspices of this permit will not qualify toward the establishment of
residence in Oregon, i.e., it is presumed that students seeking this permit intend to retain their California residency.
Melissa Green, Vice President, Student Services Date