Course Registration Form

The Counseling Department Office is on the first floor of Shippen Hall (SPH 123).

All graduate students in the Counseling Department need to complete this Course Registration form:

Date:
Last Name:
First Name:
Middle Initial:
Address:
City:
State: Zip:
Is this a new address?
Yes
No
Phone:
Business Phone:
Email:
Year and Semester
for which you are submitting
this registration
(ex. Fall 2006):


Specialization:


Credits Earned to Date: Advisor:

Primary Course Requests:

Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:
Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:
Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:
Total Credits Scheduled:


Alternate Course Requests:

Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:
Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:
Course Code:
Dept-Code-Section
 Course Title:

 Time:

 Days:

Are you a Graduate Assistant?

Yes

No

Any questions or requests: