September 2011 Module
Full Name: _______________________________________________ Student ID:________________________
Full Mailing Address: __________________________________________________________________________
Email:________________________________________ Phone (primary contact):_________________________
Section 2 - Student Status Coursework Phase (check only one)
||I am a new student. (This will be my initial registration for the ThM- Historical Theol (London) modules.)
||I have taken one or more modules.
Section 3 - September 2011 module offering
*Post-modular coursework deadline is also the deadline to submit an Incomplete Request or Notification of Withdrawal from the course. For details and instructions about submitting an Incomplete Request and/or Withdrawing from a course, please see the appropriate Degree Program Section of the catalog.
Section 4 - Expected Graduation Year: I expect to graduate in May 20_____.
Section 5 - Student Privacy Rights:
I have read the Annual Notification of Privacy Rights under FERPA. Yes _____ No _____
I am submitting a Request to Withhold Directory Information. Yes _____ No _____
Student's Signature:__________________________________________ Date:____________________
Westminster Theological Seminary, P.O. Box 27009, Philadelphia, PA 19118, Fax: 215-887-5404, email@example.com