EASTERN MICHIGAN UNIVERSITY Education First Graduate School GRADUATE STUDENT REQUEST TO ENROLL IN A 400-LEVEL COURSE (Graduate credit may NOT be earned for 100-300-level courses.) GRADUATE STUDENT completes this section: Name: ________________________________ Student Number: ____________________________ E-mail address: _________________________ Phone: ( ) ________________________________ Street: ________________________________ City, State Zip: _____________________________ Be sure course is PRE-APPROVED for graduate credit. See list on the Web @ http://gradschool.emich.edu/student/student_subdir/current_stud/approved400level/app400level.html I request permission to enroll in the following 400-level course during the following semester/year: Fall 20____ Winter 20____ Spring 20____ Summer 20____ List complete course number and title: ______________________________________________________ Note: I understand that I must complete different or additional work in order to earn graduate credit. REQUIRED: Student Signature: _______________________________________________________ Date: ______________________________________ FACULTY/INSTRUCTOR completes this section: Note: When graduate students participate in 400-level courses, additional material must be covered or projects assigned in order to qualify for graduate credit. Attach the official 400-level course syllabus to this form. In the space below, please specify what additional course materials and/or assignments will be assigned to merit the graduate-level designation or indicate information is on the syllabus. Include graduate-level learning objectives. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Print Instructor Name: ___________________ REQUIRED: Department/School of: _______________________ Instructor’s Signature: _____________________________________________ Date: ______________________________________ ACADEMIC ADVISOR completes this section: Up to nine (9) hours of approved 400-level courses may be taken for graduate credit and be applied to a graduatedegree program. (Special Topics – 477/478/479 and Independent Study - 497/498/499 courses ARE NOT APPROVED!) Courses must appear on (or be added to) the Program of Study. REQUIRED: Graduate Advisor’s Signature: _______________________________________ Date: ______________________________________ RETURN THIS FORM TO THE GRADUATE SCHOOL, 200 BOONE HALL. Fax: 734.487.0050. For Records Office/Graduate School use only: Request is: [ ] Approved [ ] Denied Signature: __________________________________ Date: _______________ Recorded on Banner __________ REV. 2/10