EmailMe Form - Request for Appointment with the Dean (RAD)

Full Name: *

First Last

Student Number: *

Current Program of Study: *

Current Semester of Study: *

Course Code: *

Course Name: *

Professor, if applicable:

Campus: *

I am a: *

Domestic Student

International Student

Email Address: *

Phone Number: *

### - ### - ####

Reason for Request: *

Whom else have you spoken to/met with? *

Please provide details related to your request and ultimate goal/resolution sought. *

Today's Date: *

MM / DD / YYYY