CERTIFICATION OF ACADEMIC
INSTITUTIONAL AUTHORITY
(Required of all applicants, first time or renewal)
I
certify that _______________________________________________________ (Name of
Student)
_________-_____-__________ (SSN) meets the
educational requirements for enrollment or re-enrollment in
this institution, and has been/will be accepted for participation in the
2008-2009 in the FALL 2008, SPRING
2009 and/or SUMMER 2009 (Circle one or more) Semester(s)/Trimester(s) indicated
below. For the purpose
of this application, the school year begins with the Fall 2008 session and ends
with the end of the Summer
2009 session.
I further certify that
this student has enrolled/plans to enroll in the following course(s) for the
academic
periods shown. The total cost of tuition, books and lab fees only for each
course is shown.
COURSE TITLE SEM/TRI YEAR CR. HRS COST
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________ ________ ______ ________ ________
_______________________________
________ ______
________ ________
(Use continuation sheet if necessary)
SIGNATURE _________________________________________ DATE ________________
PRINTED NAME __________________________________________ TITLE _____________
INSTITUTION __________________________________________ PHONE ______________
ADDRESS ___________________________________________________________________
CITY ____________________________________ STATE ______ ZIP __________________
1CDA Form 10
REV. 02-21-02