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Chemistry Enrollment Request

Please fill out all requested information and submit.

Check your schedule for changes. You will not receive notification once you are enrolled. It is the responsibility of the student if a course needs to be dropped once the requested enrollment is completed.

Student Name:

WIN #:

Course 1 CRN #:

Course 1 Number:

Course 2 CRN #:

Course 2 Number:



Student Phone #:

Student email address:

Reason for Request:

Please press "Submit Form" only once when completed. Your form will be sent directly to the Chemistry Department and a confirmation email will be sent upon receipt of this form. Alternatively, print the form and fax to (269) 387-2909, or scan and email to .

If you have questions, please contact:

Robin Lenkart
Department of Chemistry
Western Michigan University
Kalamazoo, MI 49008-5413
(269) 387-2922