To expedite processing, Please Print Clearly
Empl ID: __________________________ OR Last 4 digits of SSN ________ Daytime Phone Number: ( )___________________
______________________________________________ __________________________________________ __________ __________
Student Last Name Student First Name MI Jr., 3rd,etc.
Curricular Non- Curricular Name of Plan: ____________________________________________________________________
Origin of Request: Student School/Administrator Is this a repeat of a request made earlier for this term? Yes No
Please Print Clearly
Courses Requested
Class ID Nbr Subject Number Section Class Title
25741 IST 100 01A Introduction to Example Class
JSRCC Form No. 11 – 0034 - Page 1 of 2 08-2019
For Official Registrar’s Office Use Only: Initial Date
Reynolds promotes and maintains educational opportunities without regard to race, color, sex, ethnicity, religion, gender, age (except when age is a bona fide occupational qualifica-
tion) handicap, national origin or other non-merit factors.
Late Add Request Form
Submit only after the end of the Add/Drop period.
Complete a separate form for each School
Business Humanities & Soc. Sci. Math, Science & Engr.
Nursing & Allied Hlth.
FALL TERM (Aug - Dec) 20_____ SPRING TERM (Jan - May) 20____ SUMMER TERM (May - July) 20____
1. I have attached a copy of my Academic Advising Report which may be found in the SIS Student Center. ________ (Student Initials)
2. I have discussed this request with my academic advisor, program head, or professional advisor. ______________ (Advisor Initials)
3. I understand that I am responsible for having satisfied all placement testing requirements, prerequisites, and co-requisites prior to this
request. _________ (Student Initials) __________ (Advisor Initials)
4. I understand that if I am utilizing Financial Aid, courses above must be included on the Academic Advising Report or the applicable
substitution form(s) must be requested and approved. _________ (Student Initials) or Not applicable (Student Initials)
5. I understand that should my request be granted, payment is due immediately upon registration. _________ (Student Initials)
6. I understand that I may not attend the class if my name is not on the class roster within three days and I am responsible for contacting
the Registrar. _________ (Student Initials)
I have read and completed all items on the checklist prior to requesting the signature of the Dean.
SIGNATURE OF STUDENT: _______________________________________________________ DATE: ______________________
SIGNATURE OF THE SCHOOL DEAN OR DESIGNEE: ______________________________________ DATE: _________________
Submit to Registrar’s Office or Registrar@Reynolds.edu
Instructions: 1) After reviewing the policy on the second page, fill out this form completely. Please briefly explain the reason(s) you are making this
request. If applicable, attach any additional supporting documentation.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
2) List the course(s) requested and complete the checklist in full below. 3) Sign the form 4) Submit the form to the appropriate School Dean’s Office
5) You (the student) or the Dean’s office must submit this form to the Registrar at the Parham Road Campus, The 105 at the Downtown Campus or Advising
Services at the Goochland Campus. 6) If approved, you will be notified via your Reynolds email or text message within 24 hours by the Registrar’s Office.
