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:*

Emmaus course not offered this semesterI have a schedule conflict with the Emmaus courseI'm trying to graduate earlierI'm repeating a course to bring up my GPAOther
Signature*

Clear
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: