Admissions & Records Office, 3000 Mission College Blvd, Santa Clara, CA 95054-1897
STUDENT’S
NAME: ___________________________________________________ College ID#: ________________
LAST FIRST MIDDLE
E-MAIL: __________________________________________________ Phone: ( )_______________
Address: _______________________________________________________________________________
Section No. Course Name & No. Units Instructor
I request permission to audit the class listed above. I understand that I will not be eligible to receive
credit or a grade for this course and that I must pay a fee prior to auditing this class. I further
understand that I may not have access to all course resources, both in-person and on-line.
Signature: _________________________________________ Date: ______________________
_______________________________________________________________________________________
Completed by the Instructor of Record:
I, ______________________________________, approve this student adding the above-referenced
Print Instructor’s Name
section. I understand that I may not add a student for auditing until after Census Day for this
section to ensure that regularly enrolling students receive priority access. I further understand
that I must receive proof of paying an audit fee before allowing this student to attend this
section.
The Census Date for this section is/was: ______________________________________
Signature: _________________________________________ Date: ______________________
_______________________________________________________________________________________
Admissions & Records – Office Use Only
Fee Received by: _____________________
Date: _______________________________
COURSE SECTION AUDIT REQUEST
Reference Policy on Second Page
A&R – 02/2014
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