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Full Name (including middle initial)*:
Student ID*:
Email Address*:
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Employer*:
* Employer Information is confidential and will only be used for statistical purposes.
Semester:	(ex. Spring 2005)
Are you a candidate for graduation this semester? Yes No

CLASSES TO BE ADDED:
	Dept.	Course	CRN	Title	Day or Night
example=>	OLS	02/01	34489	Human Behavior in Organizations	Night







CLASSES TO BE DROPPED:
	Dept.	Course	CRN	Title	Day or Night

Lafayette
5500 State Road 38E, AD 2900
Lafayette, IN 47903

Phone: (765) 269-9630
Email: techlafayette@purdue.edu

College of Technology
Knoy Hall · 401 N.Grant St.
West Lafayette, IN 47907

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