Closedclass rev 07/11/2017 
 
 
 
University of the Virgin Islands 
#2 John Brewer Bay | St. Thomas, Virgin Islands 00802  
 
Albert A. Sheen Campus 
RR1 Box 10,000, Kingshill | St. Croix, Virgin Islands 00850 
 
 
REQUEST FOR ADMITTANCE TO A “CLOSED” CLASS 
 
 
Student ID Number:  _____________________ 
Please Print 
 
SEMESTER (indicate one)    Fall 
     Spring  
    Summer Session(s) 
 I or II 
    Year__________ 
 
 
Name of Student: ___________________________________________ Student Signature: _____________________________ 
 
Mailing Address: _________________________________________________________________________________________ 
 
City: ________________________________________________________ State and Zip: ______________________________   
 
 
Please complete the following:    Full-Time  
        Part-Time  
     Admitted Student    
    Non-Matriculated  
 
 
Student’s Classification:               Freshman  
    Sophomore   
    Junior  
     Senior  
      Graduate 
 
 
PLEASE NOTE: DEAN’S SIGNATURE IS REQUIRED FOR “CLOSED” COURSES 
 
 
Justification: 
________________________________________________________________________________________________________ 
________________________________________________________________________________________________________ 
________________________________________________________________________________________________________ 
 
Dean’s Signature: _____________________________________________   Date:____________________________________ 
 
CRN# 
SUBJECT 
SECTION 
COURSE TITLE 
CREDITS DAYS 
TIME 
INSTRUCTOR’S SIGNATURE 
 
 
 
                                                                                   Total Credits:_______ 
SIGN
SIGN