On-Line Course Work Only
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1Course Work Only
On-Line
Registration Approval for On-Campus Admitted Students
SUMMER
NOTE: This Form is not Required For
Courses
Requesting Permission to register for:
Course Name, Number, Course ID#:
Name: _______________________________
___________________________________
___________________________________
BSU ID #: ____________________________
Term: __ Fall __ Spring
Street Address: _______________________
______________________________________
City
State
Zip Code
Will you be enrolled in on-campus (face-to-face)
Email: ______________________________
classes this term? ___ How many credits? ____
Phone: ______________________________
Status: Full Time ___ Part time ____
STATUS: (check one)
Number of Credits completed to date: ________
FR. ___ SO. ___ JR.___ SR. ___ GRAD ___
Your Major: _________________________
Your Minor: _________________________
Indicate why you are requesting to take this online course instead of attending an on-campus
course: Check all that apply:
Internship/Student Teaching/Study
Course Not Offered On Campus This Term
Health Problems
Employed ____ Number of Hours Per Week
Course Schedule Conflict
Work Schedule Conflict
Planning to Graduate within One Semester
Child Care Responsibilities
Athletic Team Practice Schedule
Personal / Family Crisis
Preference for Online to On-Campus Courses
Distance from Campus: (# of Miles) ______
Other:
Student’s Signature: _________________________________
Date______________________
UPON APPROPRIATE APPROVALS BELOW and, AS SEATS ARE AVAILABLE,
RECORDS STAFF WILL REGISTER YOU FOR THE COURSE.
-------------------------------------------------------
_______ Advisor: ______________________________________Date______________________
_______ Instructor:______ _______________________________Date_____________________
_______ Department Chair: ______________________________Date______________________
_______ College Dean: _________________________________ Date______________________
-------------------------------------------------------
____ Reg’d & Emailed Student
Records Use Only:
____ Denied by Faculty
____ Course Full; Override Added, Emailed Student
Rev. 9/12/2013
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