UNumber*

Provide your University of Memphis UNumber

First Name*

Student First Name

Last Name*

Student Last Name

UofM Email Address*

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Phone Number*

Your Phone Number (with Area Code)

Semester of Course

Fall

Spring

Summer

Provide semester you wish to take course

Year of Course*

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Course Section Number*

Provide Course Section Number

CRN Number*

Provide CRN Number

Course Name*

Provide Course Name

Error Message / Explanation*

Please list error message (if any) and/or explain why a permit is needed.

Text Messages (Optional)

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