Rev. 03/2020
Mixed Credit Form –
Undergraduate Registration in Graduate Courses
Student Name: Student ID: FBU Email:
Local Address: Phone Number:
Undergraduate Major: Undergraduate Credits (Earned): Cumulative GPA:
Year: 20 Semester: Select only one: FALL SPRING SUMMER
Are you admitted into an Accelerated Master’s Program? Yes No If so, which program?
PART 1: COURSES TO BE TAKEN
PART 2: CHOOSE ONLY ONE TYPE OF CREDIT FROM BELOW
Dual Enrollment Graduate Credit: I understand that credit will NOT be applied to my undergraduate GPA and/or accumulated credit
hours.
Student Signature: Date:
Major Advisor Signature: Print Name: Date:
Obtain approval from Graduate Department Chairperson of the department in which the course is offered.
Graduate Depart. Chair Signature: Print Name: Date:
Accelerated Master’s Program Credit: I am in an approved Master’s Program, and I understand that credit will be applied toward both
my undergraduate and graduate GPA and/or accumulated credit hours.
Student Signature: Date:
Obtain approval from Department Chairperson of the department in which the course is offered.
Major Advisor Signature: Print Name: Date:
Depart. Chair Signature: Print Name: Date:
Grad. Prog. Director Signature: Print Name: Date:
PART 3: SUBMIT COMPLETED FORM TO THE REGISTRAR’S OFFICE FOR PROCESSING: Ryan Hall 205
Processed By: Date:
