University of Wyoming ~ College of Health Sciences ~ School of Nursing
CONSENT FOR ONLINE ENROLLMENT PETITION
This form is used to request consent for online enrollment in nursing courses for students not currently enrolled in the RN/BSN Completion Program or Masters Program.
NOTE:
This form must be completed and approved prior to registration in the course. Failure to receive consent will result in administrative withdrawal from that course.
A separate form is required for each course being petitioned and you will be notified as to the outcome.
I, hereby petition to be allowed to enroll for the following course:
Course:
Title:
During the
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Spring
Summer
Fall
Semester in
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2007
2008
2009
Consent requested for the following reason(s):
Your Personal Information
First Name:
Middle Name:
Last Name:
Student 'W' Number :
Phone:
Email:
Address:
City:
State:
Zip:
Name of Advisor:
Declared Major at UW:
Educational Background/Degree Earned (include focus):
Educational program being pursued:
Select Item
BSN On Campus
RN/BSN Online
Non-Nursing Major
MS with Nursing Bachelors
MS with RN and Non-Nursing Bachelor
Status at School of Nursing:
Select Item
Applied to Program
Admitted to Program