Chabot College | Class Schedule | Spring 2010 Spring 2010

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APPLYING FOR ADMISSION C h a b o t C o l l e g e | C l a s s S c h e d u l e | S p r i n g 2 0 1 0 CONCuRRENT ENROLLEMNT Recommendation for Concurrent Enrollment Program COURSE IDENTIFICATION 1. 2. RECOMMENDATION FOR CONCURRENT ENROLLMENT PROGRAM Submit all required documents to the Office of Admissions & Records by the application deadline date. (See website or contact Admissions Office) Completion of this form does not constitute in registration to classes. A separate approval must be presented for each semester or session in which the student wishes to enroll. STUDENT IDENTIFICATION ________________________________________________ Last Name First Name Middle STUDENT IDENTIFICATION ______________________________________________ ________________________________________________ Street Address Last Name First Name Middle ______________________________________________ ________________________________________________ Street Address City, State, Zip ________________________________________________ City, State, Zip (___)______________/____/________________________ Phone (___)______________/____/________________________ Number Date of Birth Chabot Student Id Number ________________________________________________ Phone Number Date of Birth Chabot Student Id Number ________________________________________________ Email Email ALTERNATE 1. COURSE TITLE (For example: ENGL) NUMBER (For example: 1A) UNITS (3.0) SCHOOL INFORMATION _________________________________________ Principal _________________________________________ School Name _________________________________________ School Address _________________________________________ City, State, Zip _________________________________________ Phone Number Current Grade Level: __________ Cumulative GPA: _________ In accordance with the Governing Policy Number 5124 and policies of this District, the following named student is recommended for concurrent enrollment at Chabot College. TERM FALL SPRING SUMMER YEAR: ________ ENROLLMENT STATUS NEW CONTINUING RETURNING PREREQUISITE* ALTERNATE 2. NOTE: Concurrent Enrollment is limited to a maximum of two (2) courses or six (6) units. Enrollment in physical education or basic skills courses (ENGL 101A/101B/102/107/115/116/117/118AB/119/120/121, all ESL courses, MATH 105/105L) is not allowed. Any change to the course selected above requires a new recommendation form signed by school officials. * Many courses require the completion of prerequisites courses taken at Chabot College or their equivalent at another institution. Consult the course description in the class schedule or college catalog for identification of prerequisites. Assessment must be completed prior to registration for English and Math courses. Consult Chabot College counselor for more information regarding prerequisites. 1. Courses listed above relate to the student’s projected education career pattern in the following manner: ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ 2. TRANSCRIPT: A copy of the student’s current transcript is attached and is submitted as evidence that the student will likely succeed in concurrent enrollment. 3. PARENTAL APPROVAL: A written statement of parental approval is on file with the student’s records at the high school and permission has been obtained for issuing student’s transcript to Chabot College. 4. PARENT’S SIGNATURE acknowledges students participation in the Concurrent Enrollment program. __________________________________________________________________ Date_________________________________________ 5. All students will have a Chabot College transcript. If you are currently enrolled in high school, will these courses be used for high school credit? Yes No As per Ed. Code 76001, the high school principal of the school certifies, by signing this application that no more than 5 percent of the total number of students per grade level shall be recommended for enrollment at Chabot College for the summer session. 6. Notification to register online will be provided by the Admissions & Records Office at Chabot College. Enrollment in courses not approved by the Director of Admissions & Records will be dropped 7. RECOMMENDED BY: Counselor ____________________________________________ Date __________________ (Signatures are required every term) (Counselor signature not required for students in 3 rd to 8 th grade) Principal ____________________________________________ Date __________________ FOR OFFICE USE ONLY UNITS APPROVED: ___________ Director of Admissions & Records ___________________________________ Date __________ DISAPPROVED V.P. Student Services ___________________________________ Date __________ Reason: ______________________ (VP. signature required for students in 3 rd to 8 th grade only) 6 _______________________________________
C h a b o t C o l l e g e | C l a s s S c h e d u l e | S p r i n g 2 0 1 0 PERIODO PARA EL CUAL ESTA NUMERO Y CALLE CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT Someter a: CHABOT COLLEGE 25555 HESPERIAN BOULEVARD HAYWARD, CA 94545-5001 (510) 723-6700 o VERANO o OTOÑO o PRIMAVERA AÑO: ______________ 1 2 __ __ __ - __ __ - __ __ __ __ 3 SOLICITUD DE ADMISION SELECCIONE UN COLEGIO o Chabot DIRECCION LEGAL (NO USE UN APARTADO POSTAL) __ __ __ __ __ - __ __ __ __ DIRECCION POSTAL (SI ES DIFERENTE) Solicitud de Admision o Las Positas ( ) ( ) o ESTUDIANTE NUEVO o ESTUDIANTE REGRESANDO NUMERO DE SEGURO SOCIAL FECHA DE LA ULITIMA VEZ QUE ASISTIDO A CHABOT O LAS POSITAS Mes Año __ __ __ NUMERO Y CALLE NUMERO DE APT. TELEFONO DE LA CASA CIUDAD ESTADO CODIGO POSTAL TELEFPNO DEL TRABAJO __ __ Ejemplo: D E C 9 3 APELLIDO (LETRA DE MOLDE) NOMBRE (LETRA DE MOLDE) INICIAL DEL 2ND NOMBRE CORREO ELECTRONICO PREVIO NOMBRE - APELLIDO (LETRA DE MOLDE) NOMBRE (LETRA DE MOLDE) MEDIO NOMBRE NUMERO DE APT. SOLICITuD DE ADMISION CIUDAD ESTADO CODIGO POSTAL __ __ __ __ __ - __ __ __ __ 12 14 En caso de emergencia, contacto: Nombre ORIGEN ETNICO (marque uno u más)) 4 MASCULINO FEMENINO 5 B Negro no Hispano Hispano F Filipino HM Mexicano, México-Americano, ME Middle Eastern Chicano N Nativo Norteamericano/Indi HR Centroamericano Norteamericano/Nativo de Alaska HS Sudamericano W Blanco no Hispano HX Hispano no citado 6 FECHA DE NACIMIENTO Mes Dia Año __ __ __ __ __ __ __ 7 Ejemplo: D E C 2 7 6 7 8 9 10 Es usted ciudadano de los EEUU Si No __ __ __ 11 SELECCIONE UN CODIGO DE ESPECIALIZACION (Codigo A) MAXIMO NIVEL ACADEMICO Y AÑO La fecha de su present permanece en California empezó Mes Dia Año __ __ __ __ CATEGORIA DE INSCRIPCION (tipo de estudiante) 1 = Primer ingreso al colegio después de asistir a la escuela preparatoria 2 = Nunca he aendido Chabot o Las Positas después de haber asistido a otro colegio 3 = Regresando a Chabot o Las Positas después de haber asisitido a otro colegio 4 = Regresando a Chabot o Las Positas y no he asistido a otro colegio ultima vez que asisti aqui Y = Asistiendo a la escuela preparatoria durante el periodo para el cual estoy aplicando 3 = Diplomas de la escuela para adultos A = Obtener una Licenciatura después de obtener un Titulo Asociado 1 = La asistencia a la escuela 4 = GED secundaria durante el cual 20 5 = Certificado de competencia de la prepa- B (A.A./A.S.) me aplico. — — C = = Obtener Obtener una un Titoulo Licenciatura Asociado sin (A.A./A.S.) el Titoulo Asociado (A.A./A.S.) 2 = Asistiendo a una escuela D = Obtener un Certificado Codigo G = Adquirir nuevas habiliadedes de trabajo para adultos H = Incrementar sus actuales oportunidades/habilidades de trabajo Codigo J = Enriquecimiento intelectual NUMERO DE HORAS QUE USTED PLANEA TRABAJAR DURANTE ESTE TERMINO PUERTO DE ENTRADA { ratorial 6 = Certificado de preparatoria del extranjero 7 = Titulo Asociado 8 = Licenciatura o más alto ESTATUS DE RESIDENCIA 2 = Residente Permanente 3 = Residente Temporal 3A = Solicitante De Amnistia 4 = Estatus ortorgado para asilo politico o refugiado 5 = Visa de estudiante (F-1 o M-1) 6 = Otro tipo de Visa: _________ (V-1, H-1, L-1, Etc.) 6A = Otro estatus (no es residente) 13 PAIS DE CIUDADANIA ¿CUAL ES SU PRINCIPAL META ACADEMICA? 15 ¿ES EL INGLES SU LENGUA NATIVA? SI NO (Si no, llene la caja abajo) Codigo Telefono Eres Latino u Hispano? Si No Asiatico Isleño Pacifico AC Chino PG Guamanian AI Subcont. Indico PH Hawaiano AJ Japonés PS Samoano AK Coreano PX Otro AL Lausiano AM Camboyano Otro AV Vietnamés O Otro de color AX Asiåtico no citado XD Disminuido Indicar FECHA DE EMISION DE VISA ESTADOUNIDENSE Mes Dia Año __ __ __ __ __ __ __ Ejemplo: 2 7 D E C 6 7 A = 1-9 hrs. por semana B = 10-19 hrs. por semana C = 20-29 hrs. por semana D = 30-39 hrs. por semana E = 40+ hrs. por semana N = No piensa trabajar X = No sabe Codigo FECHA DE CADUCIDAD Mes Dia Año __ __ __ __ __ __ __ Ejemplo: 2 7 D E C 6 7 L = Completar créditos para obtener el dipoma de preparatoria M = No ha decidido su meta académica N = El cambio de ningün crédito para acreditar los deberes O = Estudiante colegial de 4 años que toma el curso para encontar los requistos colegiales 16 Codigo 1 = Chino 2 = Español 3 = Tagalo 4 = Arabe 5 = Otro LA ESCUELA SECUNDARIA ULTIMA ASISTIDO (Usa la hoja de codigo B) FECHA DE DIPLOMA DE ESCULA SECUNDARIA O ULTIMA ESCUELA SECUNDARIA DE ASISTENCIA Mes Año __ __ __ __ __ Ejemplo: D E C 6 7 CP:EM 3/09 7
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Chabot College | Class Schedule | Spring 2010 Spring 2010

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