BINGHAMTON UNIVERSITY OFFICE OF THE UNIVERSITY REGISTRAR P.O. BOX 6000 BINGHAMTON, NY 13902-6000 FAX # (607) 777 - 6515

REQUEST FOR COURSE CONFLICT

Student Name: _____________________________________

Student ID# (SSN): _________________________________

I AM REQUESTING TO REGISTER FOR:

Course Name: _________ Course #: ___________ Section #: __________

Approval must be given by the instructor of the course class time you will be missing.

Instructor's signature: _________________________________