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For Office Use Only
Posted By:____________ Date Posted:___________
Office of the Registrar
Undergraduate Student in Graduate Degree Program Special Registration Request Form
Student Information
Student ID:
Email:
Name: Last Name
Phone:
First Name Middle Name
Semester: □ Fall □ Spring □ Summer 20
Course Information
instructor
CRN:
Subject and Course Number (e.g., MATH 123):
Instructor Name:
Instructor Signature:
UG Advisor Name: ______________________________________________
UG Advisor Signature: ___________________________________________
GR Advisor Name: ______________________________________________
GR Advisor Signature: ___________________________________________
Financial Aid Name: _____________________________________________
Financial Aid Signature: __________________________________________
CRN:
Subject and Course Number (e.g., MATH 123):
Instructor Name:
Instructor Signature:
UG Advisor Name: ______________________________________________
UG Advisor Signature: ___________________________________________
GR Advisor Name: ______________________________________________
GR Advisor Signature: ___________________________________________
Financial Aid Name: _____________________________________________
Financial Aid Signature: __________________________________________
Signature
After completing and signing this form, submit it in person at:
Student Signature:
Office of the Registrar 116 Allen Center
Date:
E-mail [email protected] I Office 713-348-4999 I Fax 713-348-5921 I Office of the Registrar-MS 576100 Main St. I Houston, TX 77005 I registrar.rice.edu Last revised 3/15/2018
http:registrar.rice.edumailto:[email protected]
Student ID: Name: Email: Phone: Fall: OffSpring: OffSummer 20: OffCRN: Subject and Course Number eg MATH 123: UG Advisor Name: Instructor Name: GR Advisor Name: Financial Aid Name: CRN_2: Subject and Course Number eg MATH 123_2: UG Advisor Name_2: Instructor Name_2: GR Advisor Name_2: Financial Aid Name_2: Year: