Part I
Personal Information
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| Title: |
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| * First Name: |
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| Middle Name: |
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| * Last Name: |
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Other Name Used:
(i.e. Maiden Name) |
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| * Mailing Address: |
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| * City: |
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| * State/Province: |
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| * Zip Code: |
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| * Country: |
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| * Email: |
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| * Confirm Email: |
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| * Area Code + Telephone #: |
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| United States Citizen: |
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Part II
Educational Information
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| Name of last school attended: |
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| City/State of last school attended: |
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| Did You graduate: |
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| Total years of education to date: |
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| College credits earned, if any: |
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Part III
Application for Program or Individual Courses
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| * Applying for: |
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Instructions for Part III:
( select & use only 1 Section ) |
* For a degree program, complete Section "A"
* For a certificate program, complete Section "B"
* For individual courses, complete Section "C"
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Section "A"
Online Degree Programs
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| If applying for degree program: |
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| Number of transferable credits: |
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Section "B"
Online Certificate Programs
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| If applying for certificate program: |
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Section "C"
Individual Online Courses
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| Instructions: |
Use Section "C" only if applying for individual courses.
Type in the course number and title for each course you are enrolling in.
DO NOT complete section "C" if applying for a degree program!
The definition of "number" below is the assigned course number, for example: BU340
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| Requesting individual courses: |
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Course 1
Number - Title: |
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Course 2
Number - Title: |
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Course 3
Number - Title: |
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Course 4
Number - Title: |
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Course 5
Number - Title: |
-
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Part IV
Assessment Portfolio of Previous Life Experience - APPLE Form
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| Requesting Life Credit Assessment: |
Click here for assessment (APPLE) form
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| Number of anticipated credits: |
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Part V
Processing Fee
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| Fees: |
A non-refundable application processing fee of $35.00
is required before the "Enrollment Application" or the
"Assessment Portfolio of Previous Life Experience" will
be processed by Canyon College. This fee is a one time fee
regardless of the number of courses or programs taken
thereafter.
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Part VI
Student Enrollment Agreement
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| * Student Enrollment Agreement: |
Click Here To Read The Student Enrollment Agreement
I accept all terms and conditions listed herein.
I do not accept all terms and conditions listed herein.
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Comments or Requests
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| Comments or Requests: |
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Please click the "Submit Form" button.
Note:
Upon receipt of the $35.00 processing fee,
your application will be processed within
4 working days from the date received.
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