Student Responsibility Agreement Form
Semester/year
Semester
Year
Name
First Name
Last Name
MI
State ID
VA Claim #
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select your student status
Continuing Student
New student (transfer)
New student (freshman)
Guest student
Please upload related documents here
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Degree Objective
BA
BS
MA
MS
PhD
Certificate/Credential
Other
Major(s)
Minor(s)
Have you applied any financial aid?
Cal Grant
University Grant
Pell Grant
Loans
Other
Please select your military status:
Veteran
Dependent
Active duty
Reserve
Other
Please select the one(s) applicable to you
Since last term, I am either changed majors, added a second major, or added a minor.
I applied for or I intend to apply for graduation for the term listed above.
I am Rounding Out in this term.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: