SB 1914 Cross-Enrollment Authorization Form - Department of ...

UCI APPLICATION FOR
SB 1914* CROSS ENROLLMENT ELIGIBILITY
FOR CALIFORNIA COMMUNITY COLLEGE / CALIFORNIA STATE UNIVERSITY
* Sections 66755 & 66756 of SB 1914 have been amended by SB 361
This form is to be completed by students currently registered at a California Community College or a California State
University who wish to enroll concurrently in one UCI course using the Cross Enrollment option. See reverse side for
eligibility requirements, restrictions, and enrollment procedures.
Instructions:
1. Take this form to the Registrar's Office at your home campus and have your eligibility verified.
2. Turn in this signed form, completed Cross Enrollment Authorization form, and $20/unit and $10 computer account fee
to University Extension Student Services Office (University Extension Building D).
3. The first day to enroll is the first day of instruction.
Name (First, Middle, Last)
Birth Date
Social Security Number (Optional)
Male Female
Address
Day Phone
( )
City State Zip Evening Phone
( )
Email
Home Campus
Home Campus ID#
Check term
currently enrolled at
home campus.
Fall Have you ever applied to UCI Yes Have you previously attended UCI Yes
Winter No No
Spring If yes, what year & term: _____________________
I certify that the information provided is accurate. I have read the policies and procedures for cross-enrollment and
understand the eligibility requirements, enrollment conditions, and procedures stated on the reverse side of this form. I will
comply with all procedures set forth.
STUDENT'S SIGNATURE
HOME CAMPUS REGISTRAR'S CERTIFICATION:
DATE
A student is qualified to cross-enroll if the student has met all of the
following requirements:
• completed at least one term at the home campus as a matriculated student
• enrolled in a minimum of 6 units in the current term
• 2.0 G.P.A.
• paid appropriate tuition and fees at home campus for current term
• completed appropriate academic preparation as determined by host campus
• resident of California
Campus Seal
Printed Name:________________________________
Signature:___________________________________
Title:_________________________
Date:_________________________