College of _____________________

Application for Cross-Enrolment

(in triplicate)
_____________________________
Dean

Sir/Madam:

I would like to ask permission to cross-enroll at __________________________________________________

(Name of School)
____________________________________________________ this __________________________________________
(Address of School) (Trimester/Semester/SY)

in the following subjects:

Course No. Subject Description Units

_____________________ ________________________________________ ____________

_____________________ ________________________________________ ____________
_____________________ ________________________________________ ____________

Note for the Dean: Please countersign the desired subject/s to be taken to avoid alteration.

Note for the Student:

a. Upon approval of this application, pay the corresponding fee at the UC Cashier.
b. Show the official receipt of payment and submit this duly accomplished application form to the Registrar’s Office for
the processing of PERMIT TO CROSS-ENROLL. Non-submission of this application form shall invalidate
request to cross-enroll.
c. Claim PERMIT TO CROSS-ENROLL letter from the Registrar’s Office on the specified date.

A. Check below reason/s to cross-enroll:

____ a. subject/s needed is/are not offered ____ b. dissolved subjects
____ c. conflict in schedules of subjects ____ d. subjects to be cross-enrolled is/are under
the list of “allowed subjects”.

B. Check below to indicate the number of times you have cross-enrolled.

____ first time ____ third time
____ second time ____ other, please mention ________________

__________________________________ ____________________ __________________________

Signature over printed name Student I.D. No. Course & Year Level

Approved: ______________________________ Date: __________________________

Cashier’s Receipt Number __________________ Date: __________________________

UC-VPAA-C____-FORM-___
June, 2012 Rev. 0