Name __________________________ Cal Poly Email _________________________ ID# ______

  1.  Have you taken CIS ____________ (this class) before at Cal Poly?  ________
    a. If so, did you receive credit ( C or higher for a core course, or D- or higher) for it? _____


  2. How many total units (all departments, including units this quarter) do you need to graduate? _____
        a. If you only need this one class to graduate, skip to bottom of form (signature and documentation)

  3. How many CIS units do need to graduate (including units this quarter)? _____


  4. How many CIS units are you enrolled in now (this quarter, but not counting this class)? ___


  5. How many total units did you satisfactorily complete the last quarter that you took classes? ___


  6.  Total units satisfactorily completed in quarter before last quarter you took classes? _____


  7. How many total units of college credits have you earned? Cal Poly ________   Total _____


  8. What are your GPAs?                 CIS _________   Cal Poly _________    Overall _________


  9. Were you unable to get into in this class because of a problem with the registration system?  _____

  10. Are you a member of a CIS club?  _____  Which club?  _____________ Club officer? _____


  11. Please list below all the classes that you plan to take to graduate, with the number of units (the units should total to the total shown above for question 2). List them by the quarter (starting month and year) you will be taking them, starting with the classes you are registered for this quarter:

___________________, ___________________, ___________________, ___________________

___________________, ___________________, ___________________, ___________________

___________________, ___________________, ___________________, ___________________

___________________, ___________________, ___________________, ___________________

  1. Describe below any other circumstances that should be considered in determining your position on the waiting list:

________________________________________________________________________________

________________________________________________________________________________

I certify that the above information is accurate.

Signature:      _____________________________________          Date: _______________

Please attach Degree Requirement Evaluation worksheet (official grad check or equivalent information). Also attach your Academic History, Student Study List for this quarter, and anything else required to document your answers to the questions above. (Missing or incomplete materials will move you to the bottom of this list.)