Rev. 1/24/19
CROSS MCW-CAMPUS REGISTRATION
A current medical student may request registration in class(es) offered at another MCW campus by completing
Section 1 of this form, and meeting with the appropriate campus dean as noted in Section 2 of this form.
Section 1
Name: __________________________________________________________________________________________
(Last name) (First name) (Middle name)
Home campus (circle one): CW GB MKE
Campus where you would like to register (circle one): CW GB MKE
Term for which you would like to register: Fall Spring Year: _________________________
Class(es) for which you would like to register:
(Subject: SURG, Course Number: D4608, CRN: 9137, Dates: 7/2-7/30)
Subject: ___________ Course Number: ____________ Course Reference Number: _________ Start Date: ____________ End Date: ____________
Subject: ___________ Course Number: ____________ Course Reference Number: _________ Start Date: ____________ End Date: ____________
Subject: ___________ Course Number: ____________ Course Reference Number: _________ Start Date: ____________ End Date: ____________
Subject: ___________ Course Number: ____________ Course Reference Number: _________ Start Date: ____________ End Date: ____________
Note:
The class start/end dates at each campus vary.
Therefore, specific dates must be included on this
form. If the dates are different from what is offered,
the OTR will work with the course contacts for class
date change requests. The OTR will register MCW
students for approved classes at another MCW
campus after May 1
st
for fall registration and
November 1
st
for spring registration and before any
add/drop deadlines. The OTR will notify students and
campus deans of registration via email.
Reason for request: _________________________________________________________________
Student Signature: ____________________________________________ Date: ________________
Section 2
I approve the student’s class choice(s) as noted above. I verify the student has met the course prerequisites and restrictions.
Required Campus Dean Signature: Date: _________________
ALL COMPLETED FORMS MUST BE SUBMITTED BY CAMPUS DEAN TO (with copy to Associate Dean of Curriculum for final sign off):
Office of the Registrar, M3200, 8701 Watertown Plank Road, Milwaukee, WI 53226 · acadreg@mcw.edu /414-955-8733
Section 3
I approve the student’s class choice(s) as noted above.
Associate Dean of Curriculum Signature: Date: _________________
