DE Heading

Instructor Contact Form
PSYCH-1-71701
Waitlisted or Adding?
Adding Waitlisted

Student Information:
Student ID Number *
First Name *
Middle Initial
Last Name *
E-Mail Address *
List only ONE e-mail address.
Confirm
E-Mail Address *
List only ONE e-mail address.
Phone - Work
xxx-xxx-xxxx
Phone - Home
xxx-xxx-xxxx
Phone - Message
xxx-xxx-xxxx
Student Computer Information:
Operating System / Model
Internet Service Provider
(AOL, MSN, WebTV, etc.)
Connection Method
Acknowledgments:

Before submitting this information, I understand that due to the number of requests to add, instructors will only respond to students whom they are able to add to the course. If I have not received an e-mail from the instructor by the end of the first week of the class, I should make alternate schedule arrangements.
* Please type in your initials (first letters of your first and last name).

I also understand that if I am able to add the class, after doing so, it will take at least one business day after adding the class, before I will be able to access the course on Moodle.
*Please type in your initials (first letters of your first and last name).
* Entry required in these fields.