WSU Tri-Cities

Bridges

Declaration of Intent

Before filling out the Declaration of Intent you must read the BRIDGES Program Guidelines

Personal Information:

*Name:

*Phone:

*Gender: Male Female

*E-mail:

*Current Resident Status: WA resident   non-resident

Veteran Status: Veteran   non-Veteran

CBC Information:

*CBC Student ID Number:

*Year began studying at CBC:    *Term: Fall   Winter   Spring   Summer

*CBC program option: AA (DTA)   Direct Bachelor’s Degree

*Expected Graduation Year:    *Term Fall   Winter   Spring   Summer

Transfer Information:

*Year intend to transfer to WSU Tri-Cities:    *Term Fall   Spring   Summer

*WSU Program Interest 1

WSU Program Interest 2

Additional Education Information:

*Running Start: Yes   No

Name of High School:

*AP or IB credit: Yes   No

Previous two or four year transfer credit (other than CBC)? Yes   No

Interest in support services (check all that apply):
Writing Center   Tutoring   ESL   Counseling   Disability Services

I have read and understand the BRIDGES Program Guidelines.

This declaration of intent is for students transferring from Columbia Basin College (CBC) to Washington State University Tri-Cities (WSU Tri-Cities).  By signing this declaration of intent, you certify that to the best of your knowledge, all statements on this form are true and you agree to release your academic records between CBC and WSU Tri-Cities. Academic records will include, but are not limited to, student identification number, date of birth, ethnicity, age, telephone numbers, mailing and e-mail addresses, transcripts, class schedules, counselor and/or advisor academic advising file notes, and major field of study.