Authorization to Enroll in a Course More Than Twice

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Are you a student or an advisor?*

Student
Advisor

Name:*

First Last

Select the Advisor you've met with:*

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EMPLID:

SIS ID:*

Phone:

VCCS Email:*

Personal Email:

Address:*

Street Address Address Line 2 City State ZIP Code

Class 1

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

Need to add another class?*

Yes
No

Class 2

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

Need to add another class?*

Yes
No

Class 3

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

Need to add another class?*

Yes
No

Class 4

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

Need to add another class?*

Yes
No

Class 5

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

Need to add another class?*

Yes
No

Class 6

The above-named student has previously enrolled at least twice in:*

Subject:	Course #:

The above-named student requests permission to enroll in the course again for the following term:

Semester:*

Year:*

5 digit class #:*

Subject:

Course #:*

Section #:*

Previous Enrollments

Term	Grade	Comments (Reason why unsuccessful)

The form is currently only equipped to collect 6 classes. If you need more, please submit the entries already entered and add additional classes into a new entry.

Signature

Student Signature*