Belmont University Concurrent Enrollment Form/Senior Residency Waiver Request

Concurrent Enrollment Request
Name:*

First NameMiddle NameLast Name
BUID:*
This is B00 followed by six unique digits
BUID - retype for confirmation:*
This is B00 followed by six unique digits
BUID fields must match before you can SUBMIT this form
Belmont Email Address*

Confirmation Email@bruins.belmont.edu
Degree:*
Major:*
Anticipated Graduation Term*
Anticipated Graduation Year*
Are you a Student Athlete? *
Contact your Athletic Academic Coordinator before submitting this form.
Are you a current recipient of VA Education benefits?*
Please contact the VA Certification/Academic Compliance Specialist.
Name of Academic Advisor*

First NameLast Name
Concurrent Enrollment Request has been Reviewed by Academic Advisor*
Please contact your academic advisor before submitting this form.
How many concurrent/transfer hours have you earned since your first term at Belmont?*
Note that the maximum allowed concurrent hours that a student is permitted to take once having matriculated to Belmont is 18 credit hours. If for some reason you feel your situation merits reasoning to appeal to take more than the maximum allowed hours, you may submit a Petition to Exceed Maximum Concurrent Enrollment Hours
Term in which You Plan to be Concurrently Enrolled*
Year in which You Plan to be Concurrently Enrolled*
How many concurrent enrollment courses do you plan on taking? You may request up to 4 courses. Anything above 4 courses will require another submission. Please have your request as finalized as possible before submission.*
Students may submit no more than 5 courses per term.
Classification:*
Concurrent Enrollment for Freshmen, Sophomores, and Juniors
Concurrent Enrollment for SENIORS
Waiver of Senior Residency Requirement
This section is required for ALL SENIORS with 94 or more completed credit hours. Prior to registering for courses through another institution, students must request a waiver of the senior residency requirement. Any credit hours taken without prior approval may not be accepted for transfer.
How many credit hours do you plan to complete at the concurrent institution?*
Reason for taking courses away from Belmont:*
Acknowledgement of Responsibilities
1. I acknowledge that any deviation from this specific request DOES NOT guarantee course equivalency. It is my responsibility to inform, in writing, my academic advisor and the Office of the Registrar of any changes upon approval.
2. According to the University's Academic Policies, in order to earn a degree from Belmont a minimum of 64 credit hours must be completed at four-year universities (including Belmont), and a minimum of 32 credit hours must be completed at Belmont specifically.
3. I acknowledge that I must earn a "C-" or above in order to receive equivalent credit for BELL Core, Major, or Minor courses when transferring credit from another institution.
4. It is my responsibility to send my OFFICIAL TRANSCRIPT to the Office of the Registrar when I have completed my concurrent enrollment course in order to receive approved academic transfer credit.
I understand that an official transcript from a concurrently enrolled institution (with previous approval from the Office of the Registrar) must be received within 30 days following commencement. If 30 days is exceeded without successful course(s) resolution/ receipt of the official transcript(s) then the student must apply for the next eligible commencement / degree award date.
Electronic Signature Acknowledging the Above Information

First NameLast Name
First Concurrent Course Information

Provide the below information for the course you are wanting to take at a concurrent institution.
Name of Concurrent Institution:*
Concurrent Institution City:*
(i.e. Nashville)
Concurrent Institution State:*
(i.e. Tennessee)
Course Subject/Number: (use concurrent institution's course code)*
This is letters followed by numbers. For example: ENG 1010
Course Title: (use concurrent institution's course title)*
Credit Hours: (use concurrent institution's credit hours)*
URL Link to Course Description from Concurrent Institution's Catalog:*
Course Description: Copy the course description exactly as it appears in the concurrent institution's current catalog/bulletin. Please Note: Altering the course description is NOT acceptable.
Course Description:*
Belmont Equivalency of First Concurrent Course

Provide the Belmont course information you are requesting the concurrent course to transfer for.
Provide the proposed Belmont requirement that the above requested conurrrent course is intended to fulfill, as discussed with your Academic Advisor.
Belmont Course Subject/Number or General Requirement:*
This will either be a course code such as ENG 1010 or a general requirement such as Humanities
Second Concurrent Course Information

Provide the below information for the course you are wanting to take at a concurrent institution.
Name of Concurrent Institution:*
Concurrent Institution City:*
(i.e. Nashville)
Concurrent Institution State:*
(i.e. Tennessee)
Course Subject/Number: (use concurrent institution's course code)*
This is letters followed by numbers. For example: ENG 1010
Course Title: (use concurrent institution's course title)*
Credit Hours: (use concurrent institution's credit hours)*
URL Link to Course Description from Concurrent Institution's Catalog:*
Course Description: Copy the course description exactly as it appears in the concurrent institution's current catalog/bulletin. Please Note: Altering the course description is NOT acceptable.
Course Description:*
Belmont Equivalency of Second Concurrent Course

Provide the Belmont course information you are requesting the concurrent course to transfer for.
Provide the proposed Belmont requirement that the above requested conurrrent course is intended to fulfill, as discussed with your Academic Advisor.
Belmont Course Subject/Number or General Requirement:*
This will either be a course code such as ENG 1010 or a general requirement such as Humanities
Third Concurrent Course Information

Provide the below information for the course you are wanting to take at a concurrent institution.
Name of Concurrent Institution:*
Concurrent Institution City:*
(i.e. Nashville)
Concurrent Institution State:*
(i.e. Tennessee)
Course Subject/Number: (use concurrent institution's course code)*
This is letters followed by numbers. For example: ENG 1010
Course Title: (use concurrent institution's course title)*
Credit Hours: (use concurrent institution's credit hours)*
URL Link to Course Description from Concurrent Institution's Catalog:*
Course Description: Copy the course description exactly as it appears in the concurrent institution's current catalog/bulletin. Please Note: Altering the course description is NOT acceptable.
Course Description:*
Belmont Equivalency of Third Concurrent Course

Provide the Belmont course information you are requesting the concurrent course to transfer for.
Provide the proposed Belmont requirement that the above requested conurrrent course is intended to fulfill, as discussed with your Academic Advisor.
Belmont Course Subject/Number or General Requirement:*
This will either be a course code such as ENG 1010 or a general requirement such as Humanities
Fourth Concurrent Course Information

Provide the below information for the course you are wanting to take at a concurrent institution.
Name of Concurrent Institution:*
Concurrent Institution City:*
(i.e. Nashville)
Concurrent Institution State:*
(i.e. Tennessee)
Course Subject/Number: (use concurrent institution's course code)*
This is letters followed by numbers. For example: ENG 1010
Course Title: (use concurrent institution's course title)*
Credit Hours: (use concurrent institution's credit hours)*
URL Link to Course Description from Concurrent Institution's Catalog:*
Course Description: Copy the course description exactly as it appears in the concurrent institution's current catalog/bulletin. Please Note: Altering the course description is NOT acceptable.
Course Description:*
Belmont Equivalency of Fourth Concurrent Course

Provide the Belmont course information you are requesting the concurrent course to transfer for.
Provide the proposed Belmont requirement that the above requested conurrrent course is intended to fulfill, as discussed with your Academic Advisor.
Belmont Course Subject/Number or General Requirement:*
This will either be a course code such as ENG 1010 or a general requirement such as Humanities
Please verify that you are human*
Should be Empty:

Concurrent Enrollment Request

Concurrent Enrollment for Freshmen, Sophomores, and Juniors

Concurrent Enrollment for SENIORS

Waiver of Senior Residency Requirement

Acknowledgement of Responsibilities

First Concurrent Course Information

Belmont Equivalency of First Concurrent Course

Second Concurrent Course Information

Belmont Equivalency of Second Concurrent Course

Third Concurrent Course Information

Belmont Equivalency of Third Concurrent Course

Fourth Concurrent Course Information

Belmont Equivalency of Fourth Concurrent Course