New Jersey Institute of Technology

Biomedical Engineering Department

Registration Authorization Form

STUDENT’S NAME_______________________________ SS#___________________

Track [Focus Area]:

This student has permission to register for the following courses for:

Fall___________ Spring___________Summer___________

Course I.D. Title Credits

1. ___________ ______________________________ ____

2. ___________ ______________________________ ____

3. ___________ ______________________________ ____

4. ___________ ______________________________ ____

5. ___________ ______________________________ ____

6. ___________ ______________________________ ____

7. ___________ ______________________________ ____

8. ___________ ______________________________ ____

9. ___________ ______________________________ ____

Total Credits ____

Comments:__________________________________________________________

___________________________________________________________________

___________________________________________________________________

Advisor’s Signature:_____________________________Date:_________________

I certify that I agree with the courses listed above and that I will obtain my adviser’s approval before any course is changed.

Student’s Signature______________________________Date_________________

[rev. 4-8-03]