Instructors Permission to Enroll in a Course
School of Physical Sciences
University of California, Irvine
Name:________________________________________ Student ID:_________________________
Major:_____________________________ Level: Freshman  Sophomore  Junior  Senior 
Email address:__________________________________ Telephone:_________________________
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I request enrollment in ___________________ during the __________________ ________ quarter.
(course)
(fall, winter, spring, summer)
(year)
Student Request
I am unable to enroll for the following reason:
_____ I do not have the prerequisites/corequisites.
Missing prerequisites/corerequisites
(list all):
_____ I am not the required major.
_____ The class requires Instructors approval.
_____ Other: explain request below. (including time conflict with another course)
Request:
List here all 5-digit course codes for courses you are
trying to enroll in (Lec, Dis, Lab, etc.):
(continue on back if necessary)
Student Signature:
Date:
To be completed by the Course Instructor:
Instructor Permission
I _________________________________ give permission for this student to enroll in my course.
(Instructor/Faculty)
I have explained to the student that they may be at a disadvantage by taking this class without the
necessary requirements. Based on our conversation, I feel that this student could succeed in the
course nonetheless.
__________________________________________ ________________________________________
Instructor/Faculty signature
Date
Course