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2008-2009 BUTTE COLLEGE BUILDING INSPECTION TECHNOLOGY PROGRAM

APPLICATION FOR ENROLLMENT

DATE:

PHONE: (

)

NAME:

ADDRESS:

City State

Zip

Butte College Student I.D.# (if known)

Social Security #

EMAIL ADDRESS:

BUTTE COLLEGE FEES:

_____

I will be paying my own fees.

_____

The agency listed below will be paying my fees.

Contact Person

Agency Name

Address

City

State

Zip

Phone Number

PLEASE NOTE: When you are accepted, this agency will need to send a letter of authorization for payment of fees to our office and the Butte College Bookstore.

______________________________________________

_____________________________

Student Signature

Date

ASSESSMENT: In case your assessment levels are below what we recommend (Reading – IV; English – III; Math –II), by signing the statement below you agree to its terms.

In requesting this waiver, I am stating my belief that I have the ability to pass the Building Inspection Program course(s). I understand that my placement levels do not indicate proficiency in the reading, writing and/or math skills determined necessary by the Butte College faculty for success in the course(s). I will make additional effort that may be necessary for satisfactory completion (“C” or better) of the course(s).

________________________________________________ Student Signature

______________________________ Date

FOR OFFICE USE ONLY

Please mail application to: Butte College ATTN: B.I.T. Program – AHPS 144 3536 Butte Campus Drive Oroville CA 95965

College ___________________________________

Reading Level

_____

English Level

_____

Math Level

_____

Initials:

__________

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