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Get CSUSM Student Responsibility Agreement

S _______ (initial) (If you are not in classes this document will be shredded and you are responsible for re-submitting) Last Name: First Name: Middle Initial Campus ID: SSN: DOB: Address: E-mail: @cougars.csusm.edu Phone: STUDENT STATUS qContinuing Student qEnrolled in an Extended Learning Program q Enrolled at Temecula Campus qNew Student (qTransfer OR qFreshman: INCLUDE: qCOE qVA Form 22-1995 & DD-214(VETERANS ONLY)) MILITARY STATUS (check one response) qVeteran qReservist qActi.

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