Student Information Form

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Nashville State Community College

Course Release & Student Information Form

Please read and complete this form, then click the Submit button to send it to your instructor.

I have reviewed NS Online/D2L Skills in order to be able to use the course management software used in this course, and I understand it is my responsibility to know policies and procedures for Nashville State courses.

It is my responsibility to read the Nashville State Community College Student Handbook and be aware of all registration dates, drop/add dates, last day to withdraw without penalty dates, and the last day to drop a course and receive a 'W' dates.

It is my responsibility to make sure that my instructor has all my pertinent information including complete name, street address, phone number, and a stable email address. Moreover, it is my responsibility to inform my instructor whenever the above information changes during the course of the semester.

I understand that if I do not make contact with my instructor every 2 weeks, beginning from the first day of the semester, that I will be treated according to Nashville State's attendance policy. (Please carefully read the syllabus. This policy may vary somewhat from course to course.)

Student Name

Email Address

Re-enter Email

Home Phone Number including area code

Cell Phone Number including area code

Work Phone Number including area code

Street Address

City State ZIP

Nashville State Community College complies with the Americans with Disabilities Act. If you wish to request any accommodation(s) for this class, please notify your instructor as soon as possible.

I request ADA accommodation(s) for my course.

Course Number (1 form per course)

Instructor: David Gerth, 615-353-3423, david.gerth@nscc.edu

Date

By clicking the submit button you are verifying that you understand and agree to the terms stated in this document.