University of Maryland University College Asia

Enrollment/Withdrawal Request Form

Student Name:
MyUMUC Student ID/SSN:
Email Address: Phone number:
5 Digit MyUMUC Class Number:
Course:
Title:
Session:
Location:
Day/Time of Class Meeting:
Division (confirmed by UMUC Office):

PREREQUISITE OVERRIDE ELIGIBILITY INFORMATION

(Please complete this section only if you require a prerequisite override. Without verifiable documentation of
previous successful completion of UMUC or transferable prerequisite courses, overrides will not be processed.)
1) How did you me
2) Please attach documentation to this request. If you have already provided this documentation, please
indicate where it is.
( Please circle: Yokota or Adelphi)
_____________________)

By completing this form I am officially requesting that UMUC Asia register me in the course above.
Please note that submission of this form does not constitute payment. If you are requesting tuition
assistance (TA), be sure to contact your local education office to ensure that you are eligible for TA. If
you have any further questions please contact your local field representative.

Signature: Date:

Office use only:

Received by: Processed by:

GAE Check: Confirmation email sent:
Division Check: Date:
Date: