APPLICATION FOR ARRANGED COURSE
This form, completed and signed, must be submitted to the Registrar prior to the date the
student wishes to register for the course. Submission of this form does not constitute enrollment
in the course.
Any course listed in the catalog, EXCEPT 1999, 2999, 4329, and 4999, may be taken “By
Arrangement” IF APPROVED BY THE INSTRUCTOR, THE DIVISION CHAIR, AND THE DEAN WHO
ADMINISTERS THE COURSE.
“By Arrangement” means that a catalog course is being taken at a TIME or a SEMESTER
other than when it is offered. If the course is offered during the term, DO NOT REGISTER IN THE
COURSE LISTED IN THE SCHEDULE UNLESS YOU ARE GOING TO MEET THE COURSE AT THE LISTED
TIME AND PLACE. “By Arrangement” means that the TIME the student meets the class is
ARRANGED for the convenience of the student.
Please note that Arranged Course is NOT the same as a Topics Course (1999, 4329) or an
Independent Study (2999, 4999) course.
NOTE: There is a additional fee of $100.00 for each approved arranged course.
I.D. Number Student’s Name (Please Print Full Name) Date of Application
I HEREBY APPLY TO TAKE
Dept/Course No. Course Title Credit
BY ARRANGEMENT FOR the:
FALL J-TERM
SPRING
SUMMER
I HAVE BEEN AND WILL BE UNABLE TO TAKE THIS COURSE AT A REGULARLY SCHEDULED TIME FOR
THE FOLLOWING REASON:
USE BACK OF THIS FORM FOR THE ADDITIONAL SPACE, IF NEEDED.
STUDENT’S SIGNATURE DATE
INSTRUCTOR’S APPROVAL PRINTED NAME DATE
FACULTY ADVISOR’S APPROVAL PRINTED NAME DATE
DIVISION CHAIR PRINTED NAME DATE
APPROVAL OF DEAN OF COLLEGE ADMINISTRATING COURSE DATE
DATE RECEIVED BY REGISTRAR: /IN COMPUTER: /STUDENT ENROLLED:
INDEX NUMBER ASSIGNED BY REGISTRAR:
REV:02/16/12
