Supplementary High School Information Form

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Supplementary High School Information Form
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Name
(Last) (First)

Campus Identification Number (CIN) Term:

You received this form because one or more of the items below were left blank or incomplete on your application and are needed to determine your eligibility for admission. Please sign and return this form. Incomplete or inaccurate information may jeopardize your admission to the University.

1. Enter high school GPA:

High school grade point average includes all approved college prep “a-g” courses taken in 10th, 11th, and 12th grades.
2. Enter test scores and date(s) taken:

ACT scores
EMRSComposite 		Date(s)
SAT I scores
CRMTotal 		Date(s)
 
CRMTotal 		Date(s)
 
CRMTotal 		Date(s)

3. Enter all college preparatory courses in the appropriate section. If course has been completed, enter the grade earned; if in progress or planned, enter “I” instead of grade. List only courses that can be verified by your final transcript. List college preparatory elective courses in applicable subject area (e.g. fourth year of college preparatory mathematics in mathematics section). If you are listing courses taken at a community college or at a high school other than the one you will graduate from, please write its name next to those courses. If you received or will receive two semesters of credit for a course taken in the summer, list the grade twice.

College preparatory subjects Grade level
taken		 Title of course completed,
in progress, or planned		 Semester/Summer grade
Fall Spring Summer
English – 4 years (8 semesters)
Composition and literature and other English courses designated as college preparatory.
Total English Semesters 
Mathematics – 3 years (6 semesters)
Algebra, geometry, intermediate algebra, and other advanced mathematics. Courses taken in 7th and 8th grades may be considered. Do not include pre-algebra.
Total Mathematics Semesters 
U.S. History/Government – 1 year (2 semesters)
One year of U.S. history or 1/2 year of U.S. history and a 1/2 year of civics or American government.
Total U.S. History/Government Semesters 
Social Science – 1 year (2 semesters)
Total Social Science Semesters 
Laboratory Science – 2 years (one year biological and one year physical)
Total Laboratory Science Semesters 
Foreign Language – 2 years (4 semesters)
In the same language.
Subject to waiver for applicants demonstrating equivalent competence as verified by high school.
Total Foreign Language Semesters 
Visual and Performing Arts – 1 year (2 semesters from the same area)
Art, dance, drama, music
Total Visual/Performing Arts Semesters 
College Preparatory Electives – 1 year (2 semesters)
Courses chosen from the subject areas listed above.
Total College Preparatory Electives Semesters 

CERTIFICATION — To be read and signed by all applicants to certify the accuracy of the information provided.
I certify, under penalty of perjury under the laws of the State of California, that I have provided complete and accurate responses to the items on this form. I authorize The California State University to release any information submitted by me in connection with my application to any person, firm, corporation, association, or government agency, but only to verify or explain the information I have provided, to obtain other records necessary for my application, or in connection with perjury proceedings. My signature certifies the accuracy and completeness of the information provided. I understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment.

Signed at
City and County Applicant’s Signature Date

Mail to : CSULA Admissions • 5151 State University Drive • Los Angeles, CA 90032-8530