Assembly
Exemption
  
  Complete the form and click next at end of form
 
   
 
 

Personal Data
Your Full Legal Name:
    
  Last Name (Family Name or Surname) First Name Middle Name  


SWAU E-Mail Address:   
  

ID#:   
  

Home Address:
   
 Number and Street City State Zip Code  

Phone Number:    
   Home Phone Cell Phone (if available)  


Reason for Exemption:

Taking six or less semester hours; or auditing all my classes  
Work
Nursing Clinicals - Student Teaching


Place of work:   
Supervisor:
Phone:
Date Started:


Other: