1.STUDENT ID:

2.FIRST NAME:

3.LAST NAME:

4.PHONE:

5.EMAIL:

6.ADDRESS:

7.CITY:

8.STATE:

9.ZIP:

10.I intend to establish California residency while at College of the Siskiyous.

Initial here:

11.I will complete EDUC 0670 Critical Skills Lab, a 0 Unit Non-Credit course. There is no enrollment fee for the course. 

Initial here: