Armstrong State University/Savannah State University
APPLICATION FOR CROSS-REGISTRATION
COOPERATIVE/EXCHANGE PROGRAM
Please read the instructions on the reverse side of this form before completing.
INSTITUTIONAL INFORMATION
Program Requested (Please choose only one): [ x ] Cooperative Program
[ ] Exchange Program
Enrolling Institution: [ x ] Armstrong
[ ] Savannah State
Cross-Registration Institution: [ ] Armstrong [ x ] Savannah State
Term Requested: _________ Have you ever applied to and/or attended the cross-registration Institution? [ ] Y [ ] N
PERSONAL INFORMATION
Armstrong ID: _________________
SSU ID: _________________
SS#: ________________________
Full Name (Last, first, Middle) ___________________________________________________________________
Mailing Address: _______________________________________________________________________________
City: _____________________________ State: _______ Zip Code: _______ County: _____________________
Telephone Number: ______________ Cell Phone Number: ______________
Birthdate (MMDDYY): ______________
Email: ______________________
Place of Birth: ____________________________
Class Level: [ ] Freshman [ ] Sophmore [ ] Junior [ ] Senior
Gender: M F
Major: _______________ Degree: _______
ETHNICITY AND RACE
Race (mark ALL that apply):
[ ] American Indian or Alaskan Native
[ ] White
[ ] Other
[ ] Hispanic or Latino
[ ] Native Hawaiian or other Pacific Islander
[ ] Asian
[ ] Black or African American
CITIZENSHIP STATUS
[ ] U.S. Citizen [ ] Alien, Non-Immigrant [ ] Alien, Permanent Resident
If you are not a U.S. Citizen, of which country are you now a citizen? _____________________________________
Alien Registration Number: ________________________________ Type of Visa: ________________________
COURSES REQUESTED
Dept. Prefix & Course #
Enter all information for each course. Incomplete form will be returned.
Section
CRN
Day & Time
Hrs.
[ ] I have satisfied the prerequisite(s) for this course. [ ] I am currently enrolled in the prerequisite course(s).
Dept. Prefix & Course #
Section
CRN
Day & Time
Hrs.
[ ] I have satisfied the prerequisite(s) for this course. [ ] I am currently enrolled in the prerequisite course(s).
Dept. Prefix & Course #
Section
CRN
Day & Time
Hrs.
[ ] I have satisfied the prerequisite(s) for this course. [ ] I am currently enrolled in the prerequisite course(s).
ENROLLING INSTITUTION APPROVAL
I certify that the courses requested, if successfully completed [ ] will [ ] will not be applicable to the student’s
degree program or minor requirements.
Academic Advisor: _____________________________________
Date: _______________________
I certify that the above named student has the approval of the enrolling institution listed above, and is
Enrolled and in good standing [ ]
Enrolled in 9 or more hours at the enrolling institution [ ]
Requesting to enroll in 3 or more hours at the cross-registering institution [ ]
Currently classified as [ ] in-state [ ] out-of-state for tuition classification purposes. State of Residency ________
Verified as lawfully present (if admissions term at home institution is Fall 2011 or later) [ ]
Has turned in all immunization requirements [ ]
Office of the Registrar: _____________________________________
7/9/2015
Date: _______________________
ELIGIBILITY
 Students will be limited to a minimum of three and a maximum of six credit hours of cross-registration
credit at the cross-registration institution.
 At the time of the cross-registration, the student must be enrolled in the required number of hours and in
good academic standing at the home institution.
o
Required home institution hours for SSU students: 12 hours
o
Required home institution hours for Armstrong students: 9 hours
 Students cannot apply for both programs in the same semester.
PREREQUISITES
 It is the responsibility of the student applying for cross-registration to be aware of any course prerequisites.
 If a student needs assistance in determining whether or not they have satisfied a prerequisite, the student
should contact their academic advisor.
DEADLINE AND SCHEDULES
 Cross-registration deadline is the last day of the drop/add period of the enrolling institution for the term
requested.
 Applications for cross-registration will not be accepted after the posted deadline. It is recommended that
students verify their cross-registration status with their cross-registration coordinator prior to the deadline.
 It is the responsibility of the student to be aware of deadlines at both the enrolling and cross-registration
institution and to cross-register as early as possible.
 Armstrong/Savannah State will not place students in classes that are closed/full/restricted.
DROP/ADD
 Additional courses may be added prior to the registration deadline (up to six total credit hours). The student
should email their enrolling institution’s Registrar’s Office from their student email account for any added
courses.
 Students wishing to drop a cross-registration course must complete a DROP form by the posted deadline.
This form should follow the same routing (see below) as the cross-registration form. Students must be
withdrawn at both institutions to avoid the assignment of a grade other than “W” at the end of the term.
 Students are responsible for checking their enrollment status for any changes.
ROUTING
 It is the responsibility of the student to ensure that the form is routed through both approval levels at the
enrolling institution (Academic Advisor and the Registrar’s Office). The Registrar’s Office at the enrolling
institution will then forward the form to the Registrar’s Office at the cross-registration institution.
 Contact information for the Registrar’s Offices:
Armstrong State University
Anne Schulte
912.344.3234
[email protected]
Savannah State University
Tyranise Harris
912.358.4157
[email protected]
ADDITIONAL INFORMATION
For the latest information about cross-registration, please refer to www.armstrong.edu (search Savannah State
Programs).
STUDENT SIGNATURE
I certify that the information furnished to me is true. I agree to abide by all the rules, regulations, practices, and
policies of the cross-registration institution while enrolled there.
[ x ] I request submission of my transcript from the cross-registration institution for purposes of verifying
courses taken.
Student’s Signature: ______________________________________
Date: _______________________________
FOR ENROLLING INSTITUTION’S
REGISTRAR’S OFFICE ONLY:
[ ] Students enrollment has been verified
[ ] Students payment has been verified
Date: ___________Signature:__________________
FOR ENROLLING INSTITUTION’S
BURSAR’S OFFICE ONLY:
[ ] Students enrollment has been verified
[ ] Students payment has been verified
Date: ___________Signature: _______________
7/9/2015