Concurrent Enrollment Request Form

Name (Use your formal name listed on official records)(Required)

First Last

Email(Required)

@wisc.edu addresses only

Term(Required)

Students only need permission for concurrent enrollment for fall or spring term. Students do not need permission for concurrent enrollment during the summer.

Fall

Spring

Are you studying abroad through a UW-Madison approved program (e.g., IAP)?(Required)

Yes (If yes, contact IAP and DO NOT fill out this form)

Number of UW Credits enrolled for upcoming semester(Required)

Institution name where you are seeking concurrent enrollment(Required)

(ex. Madison College, Independent Learning)

Course department name(Required)

(ex. Math)

Course title(Required)

(ex. First Semester Calculus)

Course number exactly as listed in other institution's course catalog(Required)

(ex. 034-000, or 101)

Number of credits offered for this course(Required)

Why do you want to take this course out of residence while you are enrolled at UW-Madison?(Required)

Completion of this form does not guarantee approval of permission for concurrent enrollment. This application will be reviewed by an academic dean in the College of Letters & Science who will determine eligibility and ultimately communicate approval or denial to the student.(Required)

Confirm understanding of this request and approval process and proceed to submit.