Concurrent Enrollment Request Form

Name (Use your formal name listed on official records)*

First Last

Email*

@wisc.edu addresses only

Term*

Fall
Spring
Summer

Are you studying abroad through a UW-Madison approved program (e.g., IAP)?*

Yes (If yes, contact IAP and DO NOT fill out this form)
No

Number 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.