Fillable Baltimore Student Exchange Program Cross-Registration Request Form

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Baltimore Student Exchange Program Cross-Registration Request Form

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BaltimoreStudentExchangeProgram(BSEP)
Cross-Registration Request Form
Registrar's or Records Office
For additional information about the BSEP program and participating institutions, visit
http://baltimorecollegetown.org/colleges/cross-registration/.
Please return completed BSEP request form to your institution’s registrar's or records office
Submission of grades to your inst
itution will be coordinated by school administrators
Page 1 of 2
YOUR INSTITUTION:_________________ VISITING INSTITUTION:_________________
Guidelines
Complete this form to request permission to take up to two courses per academic year at another
(visiting) institution through the Baltimore Student Exchange Program (BSEP).
Cross-registration is not available or valid for summer or intersession terms.
If this is your last semester before graduation, please consult your registrar’s or records office.
Your signature verifies you have read and agree to adhere to the academic calendar and policies,
including payment of any course related fees at the visiting institution, while participating in BSEP.
Instructions
1. Complete sections one and two.
2. Secure all required signatures in sections two and three, per your institutions requirements (some
institutions will accept email confirmations from faculty, check with your registrar’s or records office).
3. It is your responsibility to obtain the appropriate signatures before submitting the form.
4. This form must be submitted to the registrar’s or records office before the last
day
of registration for
either your institution or the institution you wish to attend, which ever date comes first.
______________________________________________
SECTION 1: Student Information
Have you ever enrolled at the visiting institution? Yes No
Senior
Class Year: Sophomore Junior Other: __________
Student ID #: ______________
____________________ Date of Birth (m-d-y): ____________________
Full Legal Name: ______________________________________________________________________
Last First Middle
Preferred Name: _____________________________ Major: _________________________________
Address: _____________________________________________________________________________
City:_________________________________________ State: __________________ Zip Code: _______
School Email Address: __________________________ Preferred Phone Number: __________________
Emergency Contact: ____________________________ Emergency Contact Number: _______________
Total credits at home institution this semester: _______ Credits needed to graduate: _________________
Intend to be registered for full-time status (minimum of 12 credits): Yes No
______________________________________________
SECTION 2: Course & Semester Information
Semester & Year course is offered: Fall Spring Year: ______
VISITINGINSTITUTION(List courses based on your priority 1
st
through 4
th
choice)
Priority Department
Code
Course
#
Section
#
Course Title Credits Course Schedule
Day/ Time
Pre-Req Met
(if required)
#1
#2
#3
#4
BaltimoreStudentExchangeProgram(BSEP)
Cross-Registration Request Form
Registrar's or Records Office
For additional information about the BSEP program and participating institutions, visit
http://baltimorecollegetown.org/colleges/cross-registration/.
____________________________________________________________________________________
Course In
structor Signature - Visiting Institution Date
*RequiredforJHU/Peabody,MICAstudentsifprerequisiteisnotsatisfied.
YOURINSTITUTIONEQUIVALENCY(To be completed by your institution’s administrator, if applicable)
Priority Department
Code
Course
#
Course Title
Department Dean Signature
(Coppin, Loyola, TU student
s)
#1
#2
#3
#4
______________________________________________
SECTION 3: Signatures (Your Institution)
*Your signature verifies you have read and agree to adhere to the academic calendar and policies,
including payment of any course related fees, at the visiting institution while participating in BSEP.
_____________________________________________________________________________________
Student Signature Date
*Require fdor all students
____________________________________________________________________________________
Academic Advisor Signature
Date
*Required for Coppin, Goucher, JHU, Peabody, Loyola, MICA, Morgan, Notre Dame, Stevenson, Towson, and UB students
____________________________________________________________________________________
Faculty/ Major Advisor Signature Date
*Required for JHU-Engineering students
____________________________________________________________________________________
Academic Advisor & Support Center Signature Date
*Required for Loyola students
____________________________________________________________________________________
Special Approval Signature Date
*Required for Coppin and UMBC ROTC students
______________________________________________
SECTION 4: Registrar’s or Records Office (Your Institution)
____________________________________________________________________________________
BSEP Coordinator Signature Date
*Required for all students
Please return completed BSEP request form to your institution’s registrar's or records office
Submission of grades to your institution will be coordinated by school administrators
Page 2 of 2
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Baltimore Student Exchange Program Cross-Registration Request Form

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Completed 28 February 2020

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