Multiple Attempts Request Form

Multiple Attempts Request Form

Students need to fill this form out if they are looking to re-take a course for the 3rd or more time. Please only submit one course each time you fill out the form
Date

MonthDayYear
Date
Name

First NameLast Name
Student ID
Email
example@example.com
Department Course to Repeat for Multiple Attempts (NOTE: This is asking about the course you wish to repeat.)
Course to Repeat for the 3rd time?
Example: ENG-1010
What is your Program of Study?
Example: Business Administration, AS
Explain the reason for the multiple repeats and what steps you have taken in the class to try to be successful
Which CSM Academic/Faculty Advisor has been assisting you?
Email address for the CSM Academic/Faculty Advisor that has been assisting you?
example@example.com
Should be Empty: