COURSE CONSENT FORM (BORROWED FROM M

COURSE CONSENT FORM (BORROWED FROM M.TOTARO)

SECTION I. VERIFICATION OF PREREQUISITES

Student Name: _________________________________________ Course: ___________________

Date: ___________________ SSN: _______________________ GPA: __________________

Cumulative Hours Earned: ____________ Level (Circle one): Junior Division Upper Division

Class (Circle one): Freshman Sophomore Junior Senior Graduate

I hereby certify that I have met all the prerequisites for the above course, that all statements on this form are true. I understand that if this is a false statement, I will not receive credit for this course or any following course for which this course is a prerequisite. The following is a listing of the prerequisites I have taken and the grade earned in each course. I understand that I will be dismissed at any time from this class if I do not meet the prerequisites.

Course No.: ___________________ Grade Earned: _____ Semester: _______________

Signature: ____________________________________

SECTION II. STUDENT ACKNOWLEDGMENT

I, _______________________, declare that I have read the course syllabus and agree with all its contents. I will abide by all

(Please Print)

of its conditions.

Signature: ____________________________________

SECTION III. OTHER ITEMS

E-Mail address (at USL): _______________________ Phone: ______________________

Major: _________________________ Code Name (**optional): ______________________

Other information I should know about you: ______________________________________

_________________________________________________________________________________

** This Code Name is used to identify your grades when they are posted. This allows you to keep track of your grades during the semester as I post them (usually on the homepage. You may choose NOT to have your grades posted. In this case, simply leave the Code Name space above blank. NOTE: If you do not give a Code Name, you will have no way to check your grades; you will simply receive your final course grade when you receive your grade report from USL at the end of the semester.