Concurrent Enrollment Request Form Name (Use your formal name listed on official records)* First Last Emailfirstname.lastname@example.org addresses only Term*FallSpringSummerAre you studying abroad through a UW-Madison approved program (e.g., IAP)?*Yes (If yes, contact IAP and DO NOT fill out this form)NoNumber of UW Credits enrolled for upcoming semester*Institution name where you are seeking concurrent enrollment*(ex. Madison College, Independent Learning)Course department name*(ex. Math)Course title*(ex. First Semester Calculus)Course number exactly as listed in other institution's course catalog*(ex. 034-000, or 101)Number of credits offered for this course*Why do you want to take this course out of residence while you are enrolled at UW-Madison?*Completion of this form does not guarantee approval of permission for concurrent enrollment. This application will be reviewed by an academic dean in the College of Letters & Science who will determine eligibility and ultimately communicate approval or denial to the student.*Confirm understanding of this request and approval process and proceed to submit.