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(Submit form to Enrollment Services) (Mt. San Jacinto Community College District)

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(Submit form to Enrollment Services)
San Jacinto Campus
Menifee Valley Campus
Temecula Higher Education Center
San Gorgonio Pass Campus
1499 N. State Street
28237 La Piedra Road
43200 Business Park Drive
3144 W. Westward Ave.
San Jacinto, CA 92583
Menifee, CA 92584
Temecula, CA 92590
Banning, CA 92220
(951) 487-3215
(951) 639-5215
(951) 639-5205
(951) 922-1327
Student ID #:
Student Name:
Address:
Number Street
Term/Year:
Phone Number:
City
State
Zip
I am trying to meet enrollment criteria for:
Course:
(e.g., Math 105)
Section number:
(e.g., 1234)
Instructor Comments:
Student Signature
Date
Instructor Signature Date
White: Student File Yellow: Instructor Pink: Student ES 880 InstructorConsent Rev: 6/20 ba
For office use only.
Instructor Consent for Clerk Initials: Date:
Instructor Consent Form
Instructor, please select one of the following:
Audition
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(Submit form to Enrollment Services) (Mt. San Jacinto Community College District)

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Completed 2 February 2021

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