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.
Date

MonthDayYear
Date
Name

First NameLast Name
Student ID
Ex: 0123457
Email
example@example.com
Department Course to Repeat for the Multiple Attempt (NOTE: THIS IS ASKING ABOUT THE COURSE YOU WISH TO REPEAT)
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: