Instructor Approved Prerequisite Override Request
Student Information
Student Name
*
First Name
Last Name
BMCC ID#
*
Student Date of Birth
*
/
Month
/
Day
Year
Date
Student Email Address
*
example@example.com
Student Phone Number
*
-
Area Code
Phone Number
Certificate/Degree Program
*
COURSE INFORMATION
Course Number
*
Section
*
Term
*
Summer
Fall
Winter
Spring
Year
*
Instructor Name
*
Instructor Email Address
*
example@example.com
Prerequisite not met:
*
Reason for Request
Work Experience
Course being taken as co-requisite
Other
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit for Instructor Review
Should be Empty: