4263 Marine Communities Form

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*Which section are you applying for?

Section 1 - 230-0520 FSection 2 - 1130-0220 F

*First Name

*Last Name

*Student ID Number

*Local Phone or Cell Number

*LSU Email Address

*Student Degree

*Anticipated Graduation Date

*Request for SEMESTER / YEAR

*TOTAL number of hours EARNED

Prerequisite: BIOL 4262

Completed BIOL 4262Currently Enrolled in BIOL 4262Have not taken BIOL 4262

If BIOL 4262 completed, list grade received:

Permission to be unenrolled from conflicting course(s). (Type "Permission Granted")

*I authorize that all information provided on this form, including any and all personal and academic data may be shared with the LSU Department of Biological Sciences Undergraduate Office to be considered for admission into the respective course(s). This data will be securely retained for a period not to exceed three (3) months. To learn more about privacy at LSU, please see the LSU Privacy Statement (www.lsu.edu/privacy).

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