Transfer Unit(s) Verification Form

Name: _______________________________________________
Last
First
MI
Financial Aid Office
1000 East Victoria Street
Carson, CA 90747
(310) 243-3691 · Fax (310) 516-4498
Student ID# __________________________________________
Transfer Unit(s) Verification Form
The Transfer Unit(s) Verification Form is used when a student plans to enroll at a community college while
attending CSU Dominguez Hills during the same semester. Students who wish to have the units attempted at
both institutions count toward their Federal Pell Grant eligibility are required to complete this form.
Please Note: If you are already enrolled in 12 units (full-time) at CSUDH, you do not need to complete this
form. After the completed form is submitted to the CSUDH Financial Aid Office, the community college will be
contacted to verify your enrollment.
To be eligible to use this form, students must be:
1) Enrolled in a minimum of six units at CSUDH or enrolled in the majority of their units at CSUDH; and
2) Have not transferred 70 units to CSUDH.
Students must obtain the appropriate advisor(s) signature before returning this form to the Financial Aid Office:
 Academic Advisor’s signature is required for General Education courses
 Major Advisor’s signature is required for lower division courses in the students’ academic major(s) and/or
minor(s)
Course(s) to be completed:
Department, Number & Title
Units
Term
Community College* Name and Address
1. ____________________________
_____ ________
_____________________________________
2. ____________________________
_____ ________
_____________________________________
3.____________________________
_____ ________
_____________________________________
*Please confirm that the community college Financial Aid Office(s) participate(s) in Consortium Agreements.
To be completed by appropriate advisor:
1. Indicate the number of units from above course(s) eligible for transfer toward baccalaureate degree: ______
2. Has this student transferred 70 units from a community college? _____Yes _____No
3. Course(s) transferable to CSUDH:
Course
____________________________________
Area (General Education area or major/minor)
___________________________________________
____________________________________
___________________________________________
____________________________________
___________________________________________
Advisor Name: __________________________
Department: ______________________________
Advisor Signature: _______________________
Date: ____________________________________
** For Financial Aid Office Use Only**
__________ Consortium mailed date
__________ FA Term updated
__________ Comment posted
__________ Consortium received date
__________ Award adjusted/locked
__________ Communication sent
Comments: