Name of student: Student ID:
Academic year:
Major(s)/Minor(s):
Course Name and Number:
Required or Elective?
If elective, list alternative options if any:
Reason for taking online class:
Course Conflict What course?
Athletics Sport:
Full Class Do you have instructor consent?
If so please include instructor email or signature
Offered Only Online Are seats available?
Other Explain:
Additional Details:
Advisor Signature: Date:
Date Submitted to the Dept:
Approved/Denied:
Details:
Permission number issued:
EOAS Initials:
Revision date: 3/4/15
Permission Number Request Form
Student Information
For Departmental Office Use Only
Course Information
Projected grad. date:
Email:
?
?
click to sign
signature
click to edit