Eastern Michigan University

Pass-Fail Application form - Graduate Students

Fall     Winter     Spring     Summer   (circle one) 20____

Name ___________________________________________________________________________

Student Number ______________________________________________________________

Address __________________________________________________________________________

_________________________________________________________________________________

Phone        Home ____________________________ Work __________________________

E-mail address ______________________________________________________________

Program of Study _____________________________________________________________

Academic Department _________________________________________________________

Pass-Fail enrollment is requested for ________________________(undergraduate course number)

___________________________________________________________________( course title)

I understand that pass-fail enrollment is allowed for undergraduate courses that WILL NOT apply to my graduate program of study. No graduate courses may be taken as pass-fail. I will consult the Course Schedule Book for the deadlines for declaring pass-fail as well as the deadlines for removing the pass-fail option in order to receive a letter grade if desired.

Student Signature __________________________________ Date ____________________

Graduate Advisor Signature __________________________ Date ____________________

Graduate School Approval __________________________ Date ____________________