Registrar: Petition for Graduate Courses for BS/MS Students Only

Registrar: Petition for Graduate Courses for (BS/BPS)/MS Student ONLY

This form is to be used by an undergraduate student, who is enrolled in a (BS/BPS)/MS program for Computer and Information Science, Communication and Information Design, or Health Information Management to request registration into a graduate level course(s) for dual level credit. The completed petition will be sent to the department chair overseeing the course who will return the form to registrar@sunypoly.edu for processing.

First Name * Required
Last Name * Required
Student ID# (please include the "U00" part of the ID#) * Required
SUNY Poly Email * Required
Your Undergraduate Program/Major * Required
- Computer and Information Science BS/MS
- Communication and Information Design BS/MS
- Health Information Mgmt (BS/BPS)/MS
Email Address of your Department Chair * Required
Permanent Address * Required
Expected Graduation Date * Required
Semester and Year Course will be Taken (ex: fall 2020) * Required
Requested Graduate Course with CRN (MGS 511 #1111) * Required
Requested Graduate Course with CRN (MGS 511 #1111)
Requested Graduate Course with CRN (MGS 511 #1111)
Requested Graduate Course with CRN (MGS 511 #1111)
List of Graduate Courses You Have Already Completed at SUNY Poly (if any)
Affirmation of Identity * Required
- I affirm that I am the student listed on this form.
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