REQUEST TO BE ADMITTED TO CHEM100W All questions must be answered or students may not continue in course!! Last Name:_________________ First Name:___________________ MI____ Student number (no t Soc. Sec. No.):______________ Official class standing (circle one): Jr. Sr. Grad Postbac Are you officially a graduating Chemistry senior, yes or no? __ If yes and there are enrollment limit issues, you must have available your Graduation Worksheet or letter Department: _______________ Regular Enrollment Status or Open University? _______________ Have you enrolled in this course before, yes or no? __If yes, did you drop, incomplete or take a grade, explain (include semester(s) and years(s) e.g. NC in Fall07):_______________________________________________________________ If took a grade as noted above are you now doing Academic Renewal, yes or no? _____ Are you enrolled in another 100W, yes or no? ___ If yes, explain: _____________ _______________________________________________________________________ MUST FILL OUT ALL PREREQ. INFO. BELOW
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MI____ Student number, enrollment limit issues, Regular Enrollment Status