Stanford University School of Medicine Non-Degree Status Enrollment

Stanford University School of Medicine Non-Degree Status Enrollment

Instuctions

University Policy on Course Enrollment: The Faculty Senate has established the policies that govern course enrollments. University policies on course enrollment and grading may be found in the Stanford Bulletin. Purpose: This form should only be used by approved School of Medicine Non-Degree Status students for course enrollment or to request a change in enrollment. Requests for course enrollment or changes in enrollment must be submitted before enrollment deadlines. Deadlines are published in the Academic Calendar. Enrollment requests/changes submitted after the quarterly deadline will not be reviewed.

In general, enrollment requests/changes will take up to 2 weeks to process. Failure to answer required form questions below will delay your enrollment request. Please send email to medregistrar@stanford.edu if there are any questions regarding the non-degree status enrollment request form.

Student Information

Legal Last Name:*

Legal First Name:*

Stanford University ID Number:

Stanford University Email Address:*

Phone number:*

Phone

Street Address:*

City:*

State:*

Postal Code:*

Citizenship Country/Countries:*

Birthdate:*

MM/DD/YYYY

Gender:*

Select or enter value

Ethnicity/Race:*

Click all that apply

Select or enter value

Other Ethnicity/Race, please specify:

BA / BS Degree Obtained From:*

Course Information

Enrollment will occur in which academic year:*

Select

Enrollment will occur in which quarter:*

Select

Course Department & Number:*

For example, SURG 245

Course Title:*

Total Number of Units:*

Total units after the change(s)

Requested Number of Units:*

Requested Grading Basis:*

Select or enter value

Instructor's Name:*

Instructor's Stanford Email Address:*

Required for obtaining enrollment approval

Course Department's Student Services Contact:*

Course Department's Student Services Contact Stanford Email Address:*

Required for obtaining enrollment approval

Supervisor's Name:*

Student's supervisor at Stanford University

Supervisor's Email Address:*

Required for obtaining enrollment approval

Authorization

I certify that the information contained on this enrollment request form is true and accurate. I authorize Stanford University to perform the above requested enrollment transaction(s) to my student record.*

Send me a copy of my responses

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