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 registrar@rice.edu 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:registrar@rice.edu

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: