C AMPUS /C LASSROOM V ISITATION R EQUEST F ORM
Prospective students may request permission to visit our campus and observe a class. In order to request a classroom visit, you must complete this form, sign and return it at least two weeks before the requested visit date. The College cannot guarantee the availability of any particular class or date for a visit. If your request is approved, you will receive a separate notice confirming your visit and itinerary. Name (First, Middle, Last): Date of Birth:
Home Address:
City:
State:
Zip Code:
Home Phone:
Mobile Phone:
E-mail Address:
Campus/Center that You Are Interested in Visiting:
Date(s) Requested for Your Visit:
Class or Classes that You Would Like to Observe:
Preferred Timeframe for Visit (e.g. Morning; Afternoon; Evening):
Would You Like to Meet with Our Admissions Office During Your Visit?
Do You Have Any Special Needs for Which You Are Requesting an Accommodation During your Visit? If So, Please Describe:
Name: Address:
Phone No: E-mail:
Parent/Guardian/Emergency Contact Information
ACKNOWLEDGMENT I, the undersigned, represent that I am a prospective student, and that I am requesting permission to observe a class for the purpose of gaining information that will help me determine whether to enroll at CCAC. If my request is approved, I understand that I will be expected to behave responsibly during my visit and adhere to all CCAC policies, rules and regulations, including the CCAC Student Code of Behavioral Conduct. I further acknowledge and understand that CCAC assumes no responsibility for supervising me during my visit, and that, if I am under 18 years of age, I must be accompanied by my parent or legal guardian during my visit.
__________________________________________________
_____________________________________
Prospective Student Signature
Date
__________________________________________________
_____________________________________
Parent/Guardian Signature (required if student is under 18)
Date
Please return this form at least two weeks prior to your requested date of visit. Forms may be returned as follows: 1. Complete, sign and fax to ______________________;
2. Complete, sign, scan and e-mail to ___________@ccac.edu; or 3. Complete, sign and mail to __________________________.
FOR INTERNAL USE ONLY
Admissions Office Approval: Dean of Academic Affairs Approval: Date Response Sent to Requestor:
Date: Date :
Appendix D
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