University Of Missouri-Kansas City Traveling Scholar Program Course Request Form Page 2
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2UNIVERSITY OF MISSOURI–KANSAS CITY
TRAVELING SCHOLAR PROGRAM
COURSE REQUEST FORM
(use separate form for each course)
ENROLLMENT INFORMATION AT UMKC
NAME
ADDRESS
STUDENT NUMBER
UMKC
HOME CAMPUS
DEPARTMENT
CURRENT DEGREE SOUGHT
HOST CAMPUS
SEMESTER: FS__
WS __
SS __
PROPOSED COURSE (List department, course number and exact title)
CREDIT HRS.
MAJOR ADVISOR’S
DATE
SIGNATURE
UMKC DEAN’S
DATE
SIGNATURE
APPROVALS
Permission to enroll as a Traveling Scholar does not guarantee that the course or space in a course will be
available.
MAJOR ADVISOR (home campus)
DATE
GRADUATE DEAN (home campus)
DATE
If there are specific technologies being utilized (such as Web CT or Blackboard) for this course,
please note them below.
FOR USE BY HOST GRADUATE STUDIES OFFICE
FACULTY MEMBER’S NAME AND
DATE
DEPARTMENT (individual teaching course)
GRADUATE DEAN’S SIGNATURE
DATE
(Host Campus)
COMPLETION OF COURSE
GRADE
DATE
SIGNATURE OF FACULTY MEMBER TEACHING THE COURSE
Revised 8/10
SGS/sgsforms/tvlsch
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