COURSE REQUEST FORM – ELAP

PERSONAL DATA

Name:
Registration:	Course:	API*
Addres
Zip Code	City:	State
Telephone:
E-mail

*API – Acadêmic Personal Index

The student identified above requests participation in the Study Mobility Program at Brandon University, according to the study plan:

Period: ( ) Fall Term ( ) Winter Term
At Brandon University	At UNILA
Code	Name and Credits	Hour Credits	Code	Name and Credits	Hour Credits

________________________ Student's Signature

UNILA’s Course Coordination Decision: ☐ Approved ☐ Denied _____________________________ Course Coordinator's Signature