Instructions: Please complete the information below. This form should be signed by the Chair of the student's major, who, upon approval, will forward it to the Director of Online Programs.

Virtual courses are those with no face-to-face meetings. The entire delivery of course content and assessment of student learning is distributed through an online learning management system, such as Blackboard.

Student Name: ___ CWID: ___

The quick brown fox jumps over the lazy dog.

Home Address:

___

Street City State Zip

Home Phone: (___) ___ Advisor: ___

Course Requested: _____ Semester: _____

Reason for Requesting to Enroll in a Virtual Course (be sure to attach relevant documentation):

Explain any Prior Success in Virtual Courses:

By signing below, the student acknowledges that since there are no on-campus meetings for a virtual course, he or she recognizes the importance of the discipline required for successfully completing a virtual course, including logging on regularly and submitting assignments according to due dates.

Student's Signature: ___

Date: ___

Chair's Signature: ___ Date: ___