Multiple Attempts Request Form

Multiple Attempts Request Form

Students need to fill this form out if they are looking to re-take a course for the 3rd or more time. Please only submit one course each time you fill out the form.
Name*

First NameLast Name
Email*
example@example.com
Department Course to Repeat for the Multiple Attempt (NOTE: THIS IS ASKING ABOUT THE COURSE YOU WISH TO REPEAT)*

ACC - AccountingART - ArtAST - AstronomyBAD - BusinessBIO - BiologyCDL - TransportationCHE - ChemistryCJS - Criminal JusticeCNT - Construction ManagementCOM - CommunicationCSC - Computer ScienceDAN - DanceDFT - DraftingDMP - Digital Media ProductionECN - EconomicsEDU - EducationEGR - EngineeringEGT - Engineering TechnologyELT - ElectronicsEMS - Emergency Medical ServicesENE - Energy Systems TechnologyENG - EnglishENV - Environmental StudiesFRE - FrenchFYS - First Year SeminarGEO - GeologyGRY - GeographyHEA - HealthHIM - Health Information ManagementHLS - Homeland SecurityHMS - Human ServicesHPM - Hospitality ManagementHST - HistoryIRW - Integrated Reading and WritingITS - Information Technology ServicesLAN - Languages and CultureMCT - MechatronicsMED - Medical AssistingMFT - Manufacturing TechnologyMLT - Medical Laboratory TechnologyMTH - MathematicsMUS - MusicNUR - NursingPHL - PhilosophyPHM - PharmacyPHY - PhysicsPOL - Political SciencePSY - PsychologyPTA - Physical Therapy AssistantSCE - ScienceSOC - SociologySPA - SpanishSTU - Student DevelopmentTED - Teacher EducationTHE - TheaterWFS - Wellness, Fitness, and Sports
Course to Repeat for the 3rd Time*
What is your Program of Study?*
Explain the reason for the multiple repeats and what steps you have taken in the class to try to be successful*
Describe the steps you will take to ensure your success in the repeated course*
Which CSM Academic/Faculty Advisor has been assisting you?*
Email address for the CSM Academic/Faculty Advisor that has been assisting you.*
example@example.com
Should be Empty: