Please fill in the lower portion of this form and take it or e-mail it
to your advisor for signature.
Arrange to retrieve the form from your
advisor and take it to your instructor for signature. You
should provide as much information as possible below to enable the faculty and the Office of Graduate
Education to determine if you are qualified to enroll in a graduate
course. Normally, the Dean of
the Office of Graduate Education approves requests only if
the student meets most of the requirements for
admission to graduate courses that were used for other graduate students
enrolled in the class.
Name (Print in First, Middle, Last Name Order): __________________________________________
Rensselaer ID Number: __________________________
E-mail: __________________________
Graduate Course Number: ____________ Course Title: _____________________________________
Term of Enrollment in the Course: _____________
Class: ___________ Your Major Department: ___________________
Overall QPA: ________
Other information that you believe qualifies you to take this graduate level course:
_____________________________________________________________________________________
Advisor's Approval Signature: _______________________________________________ Date: _______
Instructor's Approval Signature: _______________________________________________ Date: _______
______________________________________________________________________________________
Graduate Education Approval Signature: __________________________________ Date: ____________
Copies to: Registrar, Student if approved. Advisor, Instructor, Registrar, Student if denied.