Off Campus Registration Request Form

For use by currently admitted on-campus students seeking to enroll in a
Distance Education Course

ALL FIELDS ARE REQUIRED (incomplete forms cannot be processed)

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Your Current Information
First Name:
Last Name:
Email:
Day Phone:
Area code - Number
Student ID #:
Current Major:
Information About the Course You're Requesting
Year:
Term:
Degree Level:
Off-Campus Cohort:
Course Number (per Off-Campus schedule):
Prefix (e.g. BIO) Course & Section #
(Distance Ed) Course Title:
CRN:
Location:
Course Instructor Name:
Reason for Request:


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