Please Print
Clearly
STUDENT
NAME ______________________
ADDRESS ________________________
STUDENT
ID # _________ _____ _________ _______________________
SCHOOL _____________________
________ TELEPHONE______________________
SSN __________________________ GENDER ____ D.O.B.
______________________
RUTGERS
UNIVERSITY/RBHS-RWJMS, GSBS, SPH CROSS REGISTRATION
TO__________________________________
DATE_________________
The
______________________________, is a graduate
student enrolled at
It is requested that he/she be permitted to attend
the course(s) indicated below during the
______________________term, and that upon completion
of the term, his/her grade be submitted to the Rutgers Biomedical and Health Sciences-RBHS (formerly UMDNJ) Registrar via
regular
grade submission (student will be on your roster).
SIGNATURES____________________________ ________________________________
Student’s Adviser
Student’s
Dean
_____________________________________________________________________________
This form should be completed by the student
and
routed as follows:
1.
Obtain your adviser’s and dean’s signature (secure a special
permission number from the dean, if necessary—see #4 below);
2.
Obtain
the signature of the course instructor for consent to enroll;
3.
Submit
form to the Registrar,
4.
You must register
for “RBHS Exchange” (16:001:815 or 34:001:815, depending on your
school of
registration) using the index number listed in the Rutgers New
Brunswick
graduate class schedule for the same term for the appropriate number of
credits. A special permission number
obtained
from the Dean is required for 16:001:815, but not for 34:001:815. (This pseudo-course is not graded--for
billing purposes only.)
NOTE: undergraduate students will register for the course 10:832:400 for the appropriate number of credits
Course
#
Title
Permission
Granted
Insturctor's Signature
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TO:
Medical_School.htmlREGISTRAR-School
of Public Health
Please send my grade(s)
via official transcript to the
Graduate Registrar,
STUDENT
SIGNATURE
_________________________________________________________
Richard
Bird, Registrar