CALIFORNIA STATE UNIVERSITY, EAST BAY

Special Registration Petition

Office of the Registrar

Instructions:

1. Departments must complete the form, entering email addresses for student, instructor, chair and dean so the form can route for approval.

2. All approvals must be completed by the Add/Drop Deadline for the specified term and session. See the Important Dates page for deadlines.

3. After all approvers sign, the form routes back to the department so the Department Admin can build the course and enroll the student.

4. A copy of the completed form will be sent to the student and all approvers. The completed form will also be sent to Registrar’s to review course information.

Term

Year

Campus

HaywardConcordOnlineOff Site

STUDENT INFORMATION

Net ID

First Name

Last Name

Major

CSU East Bay Horizon Email Address

Phone Number

NOTE: Students are responsible for payment of any enrollment through Special Registration by the established deadlines.

COURSE INFORMATION (Must be exactly as listed in the university catalog) :

Department

Subject(Catalog# and Section)

Course Title

Grade Type

Letter GradeCredit/No Credit

Units

Please state specifically the reason for this request

APPROVER INFORMATION

Instructor Name

Instructor Email Address

Department Chair Email Address

College Dean Email Address

For Department Use Only

Enter the email address of the Department Admin who will enroll the student