◆ SpookStack

“ JS-1IE you have moved to California, when did Your present stay in California begin?......_. ' NOTE: 4 nenrefundadle application fee OL colleges A Notification of admaission fey a pw % x Wa Tend a dhebe abn a ata Natt Sr — . - r Sir sena Se Sacra bi nw EES Ere Sect at least one wWteemate fren erkeley, D. we aay tha , : . . : : . yp ar’ ‘ “4 . : . Cnmpus where oppliration fled « - loegje amily Nao, - f . me +. Pirst Nuano “Middle > 14. Mother's maiden en a ne 2 tees. od. ve ' - Family Name First Name . Pet. ‘ = ~ 1§, Name of legal Quardian, if not your father... srttetereenslastannentacemrenaeresentertecsnet 48. Permanent addressee one) Id father’ ~ ; ‘ . : oo 4 . ; a 0 degal guardian. Z AL ene ihe oe. LE er LE Tr, Cg be Bo a a an Number Street. ; City State Zips 17. My parent, legal guardian, or spouse has been a legal resident Of. LA LLE DELS fe, Middle Name . ¢ eesenwecmentene SUICE oi PND State . Month Day ¥- Mive place and dates of previous permanent residence. ™ Month - Day “ ; Year Give place and dates of previous permanent residence. 20.1 certify that I have carefully cansdered each understand that cancellation of my admission question and that my statements are truc and complete to the best of my knowledge. Furt: privileges may result if the statement of Schools attended is found to be incomplete, oo Signature #€ Applicant (IN INK) . Date of application Se wst accompany this application. Remittance should he made pavable to the order of The Re- ~~, OE the University of California, Attach\icoseince on the front of this application. Do not send cash. Before submitting your application, = sure that Pacts A, B, and C have been completed in al! respects. Incomplete applications will be'returned. © = ‘21. In the left hand column below List the courses in which you ate curren tly enrolled. In the right hand column Uist the additional courses you — com piete before entering the University. Wherever possible list courses by department, course title and number, and unit value, Course Title and Number een. i °° as ', “INIS SPACE NOT TO BE-USED BY APPLICANT fo Sophomore. (Q "Senior Cc. Lsonssseeeevust-mveseecesenteonanees Major... ‘eh if; a 3 ‘2 Haire rein Roe ey sta fe ae AS SS Pree Pon 4 Wes: “A ae ae Hay wk Ft + Seo a ee PRE Ns aes Sine CR ACOH IS Nae 6 peeked °