Student Name:
Student ID#:
Student Email Address:
Student Phone #:
Current Cumulative G.P.A.:
Adviser Name:

List courses student is requesting to take:

Course       Code    Course Title                                                 Credit Hours
   ART            101                Art Appreciation (Example)                                3
           
           
           
           
           
           
           
           
           
           
           
           
                                                                       Total Credit Hours    

List other activities student is involved with and approximate amount of
time each activity takes per week. Include athletic involvement, clubs
and organizations, work, and any other activities:

                             Activity                                    Weekly Time Commitment
  Phi Theta Kappa (Example)                                     1 hour