CSM Dual Enrollment Form Fall 2022

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Dual Enrollment Registration Form

Welcome to the College of San Mateo's Dual Enrollment Form

Welcome to CSM! We are so excited to support your journey as a college student! Please be sure you do have your G#, prior to completing this form.

Next Steps include uploading this complete Form, watch out for the steps to upload in your email following the completion of this form.

Term you are taking the course:*

Fall 2022

check one

Grade level: *

9th grade 10th grade 11th grade 12th grade

at the time you are completing the course

CSM Student ID, G#:*

Received after completing Open CCC Apply via Welcome to CSM email

High School Student ID: *

Date of Birth*

Name*

First Name

Initial (optional)

Last Name

Student Cell Phone*

Student Email*

Expected Graduation Date*

June 2023 June 2024 June 2025 June 2026

Which school district do you attend?*

High school you attend: (SMUHSD)*

High school you attend: (CUSD)*

Course(s) you intend to register for:*

BUS 100: Introduction to Business, T/Th, 5th period 12:30 - 2:00, 3.0 units COUN 240: College & Academic Success, CRN: 97792, W/F, 4th period 11:05 - 12:45, 3.0 units KINE 101: Introduction to Kinesiology, CRN: 97061, 2nd period, W/F, 8:30 - 10:00, 3.0 units

Course(s) you intend to register for:*

ADMJ 100: Introduction to the Criminal Justice, CRN: 97097, 2nd period, Tues/Thurs, 8:30 - 9:50, 3.0 units BUS 100: Introduction to Business, CRN: 97766, Tues/Thurs, 1st period, 8:30 - 10:00, 3.0 units COMM 130: Interpersonal Communication, CRN: 94524, Wed/Fri, 6th period, 1:05 - 2:35, 3.0 units CRER 100: Career Planning & Life Exploration, CRN: 97116, Tues/Thurs, 5th period 12:45 - 2:15, 3.0 units PSYC 310: Positive Psychology, 2nd period, Wed/Fri, 8:30 - 10:00, 3.0 units PSYC 310: Positive Psychology, 6th period, Wed/Fri, 1:05 - 2:35, 3.0 units

Course(s) you intend to register for: *

PSYC 310: Positive Psychology, online, 3.0 units

Course(s) you intend to register for:*

BUS 100: Introduction to Business, CRN: 97765, 7th period, Tues/Thurs, 2:10 - 3:40, 3.0 units CRER 100: Career Planning & Life Exploration, CRN: 97114, 2nd period, Wed/Fri, 8:30 - 10:00, 3.0 units

Course(s) you intend to register for: *

ADMJ 100: Introduction to Criminal Justice, CRN: 96762, 4th Period, Wed/Fri, 11:15 - 12:45, 3.0 units BUS 100: Introduction to Business, 5th Period, Tues/Thurs, 12:30 - 2:00, 3.0 units CRER 100: Career Planning & Life Exploration, 3rd period, Tues/Thurs, 10:20 - 11:50, 3.0 units CRER 100: Career Planning & Life Exploration, CRN: 97115, 5th period, Tues/Thurs, 12:30 - 2:00, 3.0 units

Course(s) you intend to register for: *

CRER 100: Career Planning & Life Exploration, CRN: 97772, 1st period, Mon-Fri, 8:30 - 10:00, 3.0 units

Parent Signature of Approval

Parent/Guardian First & Last Name*

The signature below indicates parental or guardian's permission for the student to enroll at one of the SMCCCD colleges. The college does not assume any responsibility for changes a student makes to his/her schedule, this includes all full time enrollment fees if a student enrolls in 11.5 units or more

Parent or Guardian Contact Phone #*

Parent or Guardian Signature*

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Use your mouse or finger to draw your signature above

High School Designee Signature of Approval

SMUHSD High School Designee Signature of Approval for Dual Enrollment students.

Principal or Designee Signature

I have reviewed the academic record of the student named above and recommend this student for admission to the Dual Enrollment Program. I certify that this student can benefit from this advanced scholastic or vocational course work. I understand for any grade level in my school I may not recommend for community college summer session attendance more than five percent of the total number of pupils who completed that grade prior to this recommendation, excluding Middle College High School students.

Print Name of Principal or Designee: Brian Simmons

Phone #: 650-558-2212

Signature and Title of Principal or Designee: , Director, Curriculum and Assessment