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Date Submitted: 02/10/2016 01:07 PM
California State University, Los Angeles
Office of Admissions and Recruitment
Self-Reported Transfer Admissions Supplemental Form
Please use this form to update/complete academic information on your previously submitted undergraduate admission
application to the University. (NOTE: This form is not for international applicants or domestic applicants with
foreign/non-US coursework.)
Applicant’s Name (First, MI, Last):
Application Term/Year:
Cal State LA CIN:
Additional Colleges/Universities
For institutions not previously reported on the CSU Mentor admissions application.
Units
Completed
Degree
Fee Status
(Y/N)
(Res/NR)
Good Standing Status: Are you eligible to re-enroll at all institutions previously attended?
*If “No,” list the institution(s) that you are ineligible to re-enter and explain:
Yes
City, State
Name of Institution
Enrollment Dates
(MM/YY-MM/YY)
Transferable College GPA: GPA for all transferable undergraduate college work:
No*
CSU General Education (GE) Requirements
Please list courses completed, or in progress, that meet the CSU General Education (GE) requirements in Oral
Communication, Written Communication, Critical Thinking, and Mathematics/Quantitative Reasoning. For similar course
descriptions, please visit www.calstatela.edu/admissions/golden-4-course-descriptions
This self-reported information will be verified. Failure to complete GE coursework with minimum ‘C’ grades will
jeopardize offers of admission. A ‘C-’ is not acceptable.
CSU General Education Subject
A1 – Oral Communication
A2 – Written Communication
A3 – Critical Thinking
B4 – Math/Quantitative Reasoning
Institution Where Taken
Term/Year
Course Title/Number
Grade
Please read and sign the certification below, make a copy for your records, and submit the original form to the Cal State
LA Office of Admissions and Recruitment:
Online: www.calstatela.edu/admissions/applicationupdates
Certification – please...