First Name:

Last Name:

Student ID:

Permanent address:

Zip:

City/Town:

State

University Email Address:

Telephone:

Host College:

Semester

Fall or Spring and Year. E.g. Fall 2018

Course to Add:

Subject (e.g. MAT)

Course (e.g. 101)

Course Title

This letter is to certify that the student named above meets the following criteria and is therefore eligible to cross-register for the semester indicated:

Is a full-time student at WCSUThe requested course(s) is not offered at WCSU

If the student's schedule drops below full time status (12 credits) at any time during the semester, he/she will be ineligible for cross registration. The host college will be notified of the change and the student will be responsible for the additional cost of the class(s).

By selecting the "I Accept" button, you are are agreeing to sign this form electronically and that your typed signature is the legal equivalent of your manual signature.

I Accept

Student signature (typed):

Contact Information