Columbia Basin College Bridges Declaration of Intent

Campus (Hidden)

Inquiry Status (Hidden)

Current School (hidden)

School CEEB (hidden)

Have you earned less than 45 quarter credits at a partnering Bridges Program institution (CBC)?*

Yes

No

How many quarter credits have you currently completed?*

What type of student are you?*

Personal Information

First Name*

Last Name*

Birthdate*

Email Address*

Mailing Address:*

Country

Street

City

Region

Postal Code

Cell Phone*

Okay to text*

Yes

No

Current Resident Status

Washington Resident

Non-Washington Resident

Veteran Status

Veteran

Non-Veteran

Columbia Basin College Information

CBC Student Number*

Year you began studying at CBC*

Term you began at CBC*

Fall

Winter

Spring

Summer

Expected CBC Graduation Year*

Transfer Information

Term and year you intend to transfer to WSU Tri-Cities*

WSU Tri-Cities Program of Interest

Additional Education Information

Name of High School

AP or IB credit in high school

Yes

No

College credit from an institution other than CBC*

Yes

No

Other College Name

Under federal legislation, The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), I understand that my educational records cannot be released without my written permission. I, therefore, request that my enrollment records, including grades, transcripts, financial aid, and schedule information, be released to WSU Tri-Cities. I also request that my enrollment records be released to Columbia Basin College from WSU Tri-Cities once I am a WSU student for the purpose of reverse transfer, notification of degree completion and program evaluation. *

Yes

Please type your full name in the box below. This will be considered your electronic signature.*

Please upload your unofficial college transcript.