College of Staten Island
 The City University of New York
 
  

Career and Scholarship Center
 Co-Curricular Transcript Entry/Validation Form

Please fill out one form for each entry
Name:
Expected date of graduation: Semester:        Year:
Activity name:

Type of activity (Check only one):

Refer to Types of Co-Curricular Activities

Leadership
Organization, Programs, Activities
Professional or Educational Development
Honors, Awards, Scholarship, Recognition
Community Service/Volunteerism

Please provide a brief description of the activity and your involvement:

Enter the semester(s) and date(s) of your participation or honor:

 
Verifying Official’s Name:
Campus street address:
City: 
State:         Zip:
Email:
Phone: ( ) -

 
Student's name:
Today's date: 05/19/2013
Student's street address:
City:
State:         Zip:
Email:
Phone: ( ) -