FORM 13 Central Connecticut State University
Office of the Registrar
ENROLLMENT IN 500 LEVEL COURSES BY UNDERGRADUATES
________________________________________ _________________________________________
First Middle Last Student ID Number
________________________________________ _________________________________________
NEW Permanent Address Street CCSU Email Address
________________________________________ _________________________________________
City State Zip Code Phone Number
Check One: BA___ BS___ BSED ____ BSN ____ BFA _____
Check One: Full Time ___ Part Time ___
Major ___________________________________ Semester Hours Earned: ____ GPA: _____
Undergraduate students who have a cumulative average of 3.00 or above and who completed more than 90 semester hours of
coursework may request permission to enroll in a 500 level course, for which they have met all course pre-requisites.
Undergraduate students must complete this form. The signatures must be obtained from: (1) Student’s Advisor, (2) The Class
Instructor, (3) The Department Chair offering the course and (4) Dean of Graduate Studies.
I wish to enroll in the following 500 level course __________________________ during the __________________ semester.
__________________ ___________________________________________ ______________
Course Number Course Title Credits
Justification for enrolling in this Course ___________________________________________________________________
Check one:
_______ I request that the credits be counted toward my undergraduate degree requirements. (Appropriate substitution required).
See Degree Auditor in the Registrar’s Office regarding any questions.
_______ I request that credits NOT be counted towards my undergraduate degree. See the Graduate Advisor for approval if you
want to use them later towards the graduate program.
____________________________________________________________________________ ______________
Advisor Approve Disapprove Date
____________________________________________________________________________ ______________
Instructor Approve Disapprove Date
____________________________________________________________________________ ______________
Chair of the Department offering course Approve Disapprove Date
____________________________________________________________________________ ______________
Dean of Graduate Studies Approve Disapprove Date
Please complete this form and return to the Office of the Registrar for processing.
Davidson Hall, Room 116, 1615 Stanley Street, New Britain, CT 06050
Fax it to 860-832-2250 or email it to regstaff@ccsu.edu
