September  2011 Module

Section 1

Full Name: _______________________________________________  Student ID:________________________

Full Mailing Address: __________________________________________________________________________

Email:________________________________________  Phone (primary contact):_________________________

Section 2 - Student Status  Coursework Phase (check only one)

Section 3 - September 2011 module offering

*Post-modular coursework deadline is also the deadline to submit an Incomplete Request or Notification of Withdrawal from the course.  For details and instructions about submitting an Incomplete Request and/or Withdrawing from a course, please see the appropriate Degree Program Section of the catalog.

Section 4 - Expected Graduation Year:   I expect to graduate in May 20_____.

Section 5 - Student Privacy Rights: 

I have read the Annual Notification of Privacy Rights under FERPA.   Yes _____     No _____

I am submitting a Request to Withhold Directory Information.            Yes _____     No _____

 
Student's Signature:__________________________________________   Date:____________________

 
Westminster Theological Seminary, P.O. Box 27009, Philadelphia, PA 19118, Fax: 215-887-5404, registrar@wts.edu