NAME: _________________________________________				UC ID: M____________________
DEPARTMENT OF MATHEMATICAL SCIENCES
COURSE FORM
ACADEMIC YEAR  __________________________
Please list each course you are registered for, the number of credit hours for each course, and the total number of credit hours for each quarter.  Please return the completed form to the Graduate Program Director.
AUTUMN QUARTER
Course Name		Course Number		Credit Hours
		total credit hours:
print advisor's name		signature of advisor				date signed
WINTER QUARTER
Course Name		Course Number		Credit Hours
		total credit hours:
print advisor's name		signature of advisor				date signed
SPRING QUARTER
Course Name		Course Number		Credit Hours
		total credit hours:
print advisor's name		signature of advisor				date signed