Assembly
Exemption
SSL Certificate
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:
