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First Name: *
Middle Initial:
Last Name: *
Street Address: *
City/Town: *
State: *
Zip Code: *	(Format: XXXXX-XXXX)
E-mail: *
Daytime Telephone:	(Format: XXX-XXX-XXXX)
Evening Telephone:	(Format: XXX-XXX-XXXX)
What is your Date of Birth? *	(Format: MM/DD/YYYY)
Educational Goal *
to transfer to a four-year college or university by earning an Associate of Arts (AA), Associate of Science (AS), or an Associate of Arts in Teaching (AAT). to enter a new career by obtaining an Associate of Applied Science (AAS) degree and enter the job market or to transfer into another college to continue my career program. to update my job skills by earning a certificate, which requires fewer credit hours than an Associates of Applied Science degree. to transfer prior to receiving a degree. to take courses for personal interest or professional development WITHOUT earning a degree or certificate.
Anticipated Date of Enrollment	Fall Spring Summer Other
Have you previously attended classes or programs at CSM?	Yes No
Have you previously attended classes at another college or university?	Yes No
Comments or Questions

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