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Inter-Campus Course Registration Form

Terms and instructions

By submitting this form, I certify that I have reviewed course pre-requisite/requirement information and that I will adhere to the policies/dates on home and host campuses for dropping courses without financial penalty. If I choose to drop the course, I will submit the Inter-Campus Course Exchange Drop form to both home and host campus officials according to the official course drop deadline for the host campus.

Information About You

Full Name

Student ID

Date of Birth

Select Your Campus

Email Address

You must use your UMass email address.

Phone Number

Are you an International Student

YesNo

Visa Restrictions Acknowledgement

I acknowledge that as an international student, I am allowed to take only one virtual course per semester. If I am registered for more than one virtual course my visa status will be affected.

U.S. Mailing Address

Street Address

City

State

Zip Code

Advisor Information

Advisor Name

Advisor Email

It is important that your student advisor email is provided accurately. Faculty directories for each campus are listed below. The links will open in a new tab.

Faculty Directories: Amherst, Boston, Chan Medical, Dartmouth, Lowell

Course Information

Course Title

Host Campus:

Course Subject

Course Number

Course Section

Credits

Term/Year

Contact Information