Concurrent Enr From UT Southwestern MC
The University of Texas Southwestern Medical Center
Concurrent Enrollment at The University of Texas Health Science Center at Houston
Step I
Semester SSN#
is currently enrolled as a (% time) student in the school of at UT Southwestern MC
Please permit enrollment in courses listed in STEP III.
Advisor's Signature Date
Step II
Student Data
(To Be Completed By The University of Texas Southwestern Medical Center's Registrar's Office)
Classification Undergraduate Graduate
U.S. Citizen Yes No Visa Type
(If not a U.S. Citizen or permanent resident, go to the UTHSC-H's International Office for signature).
International Office Approval
Tuition Status:
Tuition Waiver Eligibility: Yes
County
No Rule:
State Country
2)
3)
1)
Registrar's Signature Date
Course No.
Step III
(To Be Completed By Student)
The University of Texas Health Science Center at Houston
Course Title Cr. Hrs.
Instructor's Approval Date
Approval
Registrar's Signature Date
I request that my grades for the above course(s) be forwarded to the Office of the Registrar at The University of Texas Health
Science Center at San Antonio after the completion of the course(s).
Date
Students Need to Give Copies to:
Home School
Host School
Self
Signature of Student
0632611188
