Brandeis University Office of the University Registrar
Time Conflict Form
First Name:
Student Information
Last Name:
Sage ID: 2
Email: @brandeis.edu
School: Undergraduate GSAS Heller IBS Term: Fall Spring Summer Year: 20
Students on academic probation are obliged to attend all class sessions. Students who are not on academic probation
may attempt overlapping courses at their own risk. Students are responsible for all materials covered in class whether or
not they are in attendance. The student’s signature below acknowledges these obligations.
Student Signature: Date:
Conflict Details
Please include mandatory attendance dates (tests, exams, etc.) for each course, and explain how the conflict will be
accommodated before obtaining either instructor’s signature:
Required Signatures
The signature of both instructors signify that they are mindful of the time conflict, that they do not object to the
student’s plans, and that no irregularities or conflicts will arise from them in the administration of final exams.
Class that you are currently enrolled in:
(Subject and Course Catalog No. i.e. AAAS 5a Section 1)
Print Instructors Name: Signature:
Class that you are not currently enrolled in due to the time conflict:
(Subject & Course Catalog Number i.e. AAAS 5a Section 1)
Print Instructors Name: Signature:
Brandeis University
.
Registrar’s Office
.
Mailstop 068
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415 South Street
.
Waltham, MA 02453
registrar@brandeis.edu
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Phone (781)736-2010
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Fax (781)736-3485
