THE CALIFORNIA STATE UNIVERSITY
APPLICATION FOR INTRASYSTEM VISITOR ENROLLMENT
(See instructions on accompanying sheet)		 V

This application is to be used by California State University students who wish to transfer temporarily to another CSU campus in visitor status.

PART I. TO BE COMPLETE BY STUDENT
A. 1.  Home Campus ______________________________  2. Proposed host campus________________________________

3.  Semester/Quarter in visitor status______________ 4.   Home campus file no.___________________

5.  Have you ever applied for admission or enrolled at host campus?  ___No    ___Yes   If yes, when?______________

6. Legal Name______________________________________________________________________________________
(Last) (First) (Middle) (Maiden)
7.  Student ID Number __________________________ 8.  Date of birth _________/ _________/ _________
  (Month) (Day) (Year)
9.  Mailing Address ___________________________________________________________________________________
(Street) (City) (State) (Zip Code)
10. Home Phone ______________ 11. Message Phone______________ 11b. E-Mail____________________________

12.  Class level at time of planned enrollment: ___Freshman ___Sophomore ___Junior ___Senior ___Graduate

13.  Major field__________________________________ and/or credential objective___________________________

14.  Last high school attended (freshmen and sophomores must complete).

  ___________________________________________________________________________________
(School) (Date of Graduation) (City) (County in Calif.) (State)

15.  Are you a veteran of U.S. Armed Forces?  ___No   ___Yes     If yes, discharge date__________________

16.  Indicate any major physical handicap or health problem for which some assistance or consideration should be provided.

  ___________________________________________________________________________________
17.  Are you receiving financial aid?    ___Yes    ___No 17a. Sex     ___Male    ___Female

B. Listing of course(s) planned at host campus: (If a planned course is a major requirement at the home campus, approval of the department chair at the home campus is required).
Courses at host Campus Units
Q    S		 Equivalent Courses at Home Campus Units
Q    S		 Department Chair Approval
             
             
             
             
I certify that the information I have entered above is true and that I have read and understand the eligibility requirements, enrollment conditions and procedures as stated.
Signature____________________________________________ Date________________

PART II. TO BE COMPLETED BY HOME CAMPUS

Residence status for fee purpose   ___ Resident     ___ Nonresident
County of residence________________________________with code of______________________
Student is currently an international (visa) student   ___ Yes      ___ No

REGISTRAR"S CERTIFICATION: I certify that this student's residence and academic status are correct according to the official records of this campus, that the student is eligible as of this date to register as a continuing student, that the student qualifies for temporary transfer in accordance with Section 40808 of Title 5, that the student has complied with pertinent health-related requirements, and that this institution approves this request for temporary transfer for one term only.


Signature_____________________________________

Title________________________________________

Home Campus________________________________		 Date_________________





CAMPUS SEAL or STAMP