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Personal Information

Full Name *

SMC Student ID *

SMC Email *

Phone Number *

Phone Number, part 1

Phone Number, part 2

Phone Number, part 3

Course 1

1 CRN *

1 Subject *

1 Course No. *

1 Instructor *

Need to add a second course? *

1 Subject: Other *

Please indicate the subject above.

Course 2

2 CRN *

2 Subject *

2 Course No. *

2 Instructor *

Need to add a third course? *

2 Subject: Other *

Please indicate the subject above.

Course 3

3 CRN *

3 Subject *

3 Course No. *

3 Instructor *

Need to add a fourth course? *

3 Subject: Other *

Please indicate the subject above.

Course 4

4 CRN *

4 Subject *

4 Course No. *

4 Instructor *

Need to add a fifth course? *

4 Subject: Other *

Please indicate the subject above.

Course 5

5 CRN *

5 Subject *

5 Course No. *

5 Instructor *

5 Subject: Other *

Please indicate the subject above.

Student Rationale

Have you attended this course at least one time? If yes, give specific details below. If no, simply type 'No' in the box below. *

Have you submitted any assignments for this specific class, or taken a quiz or test in this class? If yes, give details below. If no, simply type 'No' in the box below. *

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