Instructor Approved Prerequisite Override Request
Student Information
Student Name
*
First Name
Last Name
BMCC ID#
*
Student Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit 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
Student Signature
*
Student Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Typed Name
*
Type your full legal name. Your typed name will appear on the final PDF and will serve as your electronic signature for this request.
Submit for Instructor Review
Should be Empty: