Acadeum Course Request

Acadeum Course Request
Full Name

FirstLast
Emmaus Student ID
Date of Birth
Emmaus Email
example@example.com
Cell Phone Number

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Major
Advisor
Advisor email
advisor@emmaus.edu
PLEASE NOTE: All Acadeum course requests must be approved by your advisor.
I need an Acadeum course to substitute for the following Emmaus course:
I would like to take the following ACADEUM course for the course above (if known):
Reason for taking the Acadeum course:

Other
Signature
This form must be completed, approved, and submitted to the Registrar in order to be enrolled in Acadeum and in the requested course.
Jani Email
example@example.com
Should be Empty: