Semester: Fall __________ Spring
1143000-103505CALIFORNIA STATE UNIVERSITY, SACRAMENTOACCELERATED COLLEGE ENTRANCE PROGRAM (ACE)Application for ACE Enrollment 00CALIFORNIA STATE UNIVERSITY, SACRAMENTOACCELERATED COLLEGE ENTRANCE PROGRAM (ACE)Application for ACE Enrollment 152400-57023000 Semester/Year: Fall Spring 2020 A. Student Information [Please print legibly using black or blue ink] Sac State ID# orSocial Security # [Last 4-digits ONLY]: Current Grade (Check one) FORMCHECKBOX 11 FORMCHECKBOX 12 Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Sex: (Check one) FORMCHECKBOX F FORMCHECKBOX M (Last, First, Middle - as it appears on SSN card)E-Mail Address: FORMTEXT ????? Birthdate: / / 0 Month Day YearAddress: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????City: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? State: CA Zip: Telephone #: ( ) 9 Name of High School: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? County of Residence: FORMTEXT ?????Have you applied to attend Sac State as a college student for next year? (Check one) FORMCHECKBOX YES FORMCHECKBOX NOIf new to ACE, you must also complete the Online Application and staple your CSUMentor Confirmation Page to this application. (Check one) FORMCHECKBOX YES, I AM NEW TO ACE & HAVE ATTACHED THE CalStateApply CONFIRMATION PAGE FORMCHECKBOX NO, I HAVE PREVIOUSLY ENROLLED IN ACE [NOTE: A required fee for ACE will be billed directly to you via email 1-2 months after the term begins. Option to pay online with credit card or snail-mail in check. Failure to pay may lead to being dropped from ACE and your Sac State class plus withholding of college transcript.]Sac State ACE class you intend to take: ___CHDV 35______________Student Signature: ________________________________________________ Date: FORMTEXT ????? B. Parent/Guardian Signature“The above named student has my permission to enroll in the ACE Program at Sac State. I understand that I am responsible to pay the $36.00 tuition for this semester in ACE. If I do not pay, my student will not receive credit and I will still owe CSUS $36.00.”Print Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Date: FORMTEXT ?????Signed: ____________________________________________________________________________C. High School ACE Instructor or Other High School Official Signature"The above student is capable of achieving a ‘B’ grade or higher in the indicated course(s) and I recommend this student be permitted to enroll at Sacramento State concurrent with high school enrollment."Print Name: FORMTEXT ?????Trish Keller FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Date: __________Signed: __________________________________________________________________________Position: FORMTEXT ?Instructor????High School: Vista Del Lago High School D. Sac State ACE Office Use OnlyACE Director Recommendation 68580011112500"This Student is recommended to enroll in Sac State courses as a Special Student in the ACE Program."Signed: ____________________________________________Date: FORMTEXT ?????Data Reviewed:√ School Records (GPA) FORMTEXT ????? FORMCHECKBOX Test Scores (Specify) FORMCHECKBOX CAHSEE, SAT, PSAT, ACT, Campus Diagnostic Math Test (Circle) FORMCHECKBOX Other FORMTEXT ?????√ Advanced Instruction Completed FORMCHECKBOX Interview√Academic Department ReferralComments: High School-based site - ACE program E. Sac State Registrars Office Use OnlyACE Enrollment Location: Off-campusHigh School: FORMTEXT ????? FORMTEXT ?????Course: ________________________________Form of Payment:Mail (Personal Check): _____ Online (Credit Card): _____ ................
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