Chesapeake College
Wye Mills, MD
Office of the Registrar
Student’s Request to Take Course(s) Off Campus
Please Return Completed Form To The Registrar’s Office Before you register for the course(s)
_____________________________________ __________________________ ______
Last Name First Name M.I.
_____________________________________ ___________________________________
Social Security Number/Student ID Major
_____________________________________ ___________________________________
Phone Number E-mail address
I request permission to take the following courses at:
College or University
___________________________________________ During The Fall __________
Location Spring __________
Summer __________
Chesapeake Chesapeake
Course # Course Name Credits Course # Credits
________ __________________________ __________ ___________ ________
________ __________________________ __________ ___________ ________
________ __________________________ __________ ___________ ________
Student must present school course description(s) to registrar for course review and approval.
College and University must be regionally accredited.
Student must request College or University to send official transcript directly to the Registrar’s
office upon completion of course work. Minimum grade requirements are based upon Chesapeake
College and Maryland Higher Education Commission Transfer Policies.
Only credits (not the grades or quality points) are transferred.
This form, completed and authorized, indicates that the above named student is eligible to return to
Chesapeake College, is in good standing at the College, and appears to meet any prerequisites(s) for
the above noted course(s).
______________________________________ ____________________ __________
Registrar/Transfer Advisor Title Date
______________________________________ ______________
Student Signature Date