PBS Permission Course Request Form

Requests for 2013 -2014 Permission Courses begins May 1, 2013

Updated 4/29/13

Note: It is your responsibility to follow-up with Nancy Tenney to confirm your placement in a permission course. Do not assume that your request has been approved! You will only be contacted if you are admitted to a course.

Information about You

First Name*	Middle	Last Name*

Student ID#*	Expected Graduation Date*

Information about Your Course Request

I would like to use this course as part of my:*

Psychology Major
Psychology Minor
Neuroscience Major
Neuroscience Minor
Other:

Please specify which course you would like to enroll in.

Course #:* Term:* Hr:*

Title:*

How does this course fit with your major courses?*

If we are unable to grant you permission for the requested course, which course would be your second choice?

Course #: Term: Hr:

Title:

How does this course fit with your major courses?

Which course would be your third choice?

Course #: Term: Hr:

Title:

How does this course fit with your major courses?