08/13 AR
Verification of intent to earn
Associate of Arts/Science Degree – Transfer
1
Type or Print all information.
Student Name
2
:
Student ID: Month/Day of Birth:
Mailing Address:
PO Box / Street Address
City State Zip Code
E-mail Address Primary Phone Number
Student Signature
3
: Date:
1. Information regarding completion of qualifying AA-T/AS-T will be considered self-reported until verified by a community college transcript
documenting completion of degree.
2. Legal name under which a student applied to a CSU campus should be listed.
3. Your signature indicates that you have applied for admission to one or more CSU campuses with the intent to earn an AA-T/AS-T Associate
Degree in Transfer at a California Community College prior to CSU enrollment.
Following completion of your AA-T/AS-T degree evaluation, submit a copy of this form to the admissions office at
each CSU campus to which you have applied. Forms should be submitted to Attn: Admissions.
For CSU campus addresses, please visit www.calstate.edu/transfer
Columbia College ~ Office Use Only
Degree / Academic Program Term / Year
Anticipated course completion - Year: Fall Spring Summer
By signing this form, the official at the community college at which the student intends to earn the AA-T/AS-T degree is
verifying that the student has completed more than half of the graduation requirements for the degree and could complete
the degree within the remaining standard academic terms prior to transfer.
Evaluator Signature: Date:
Evaluator Printed Name: Title:
Received: Campus ID:
Admissions & Records Specialist
