Distance Education Preauthorization Application Form

Personal Information

Enter your name as it appears on your UO registration.

First Name

Last Name

UO Student ID number (95#)
Please provide full nine-digit number; preauthorization requests submitted with incorrect or incomplete student ID numbers will not be processed.

E-mail (Haven't set up your account?)

Course Information

Course Title (example: "ASTR 121")

Course Reference Number (CRN)
(Example: 25104)

 Fall
 Winter
 Spring
 Summer

Please answer the following questions.

Reason For Choosing an Online Course
(Check the box or boxes which apply.)

Schedule Conflict
(conflict with other courses, employment, athletics, family responsibilities)

Out of Area
(traveling, moving, live out of state)

Meet UO Requirement
(for total hours, graduation, degree completion)

Other Requirement
(professional certification, another school's requirement)

Subject Interest
(personal interest in subject matter, preference for online delivery)

Health
(personal health/physical difficulty, care of family member)

Other (please specify)

Where did you hear about the Distance Education program?
(Check the box or boxes which apply.)

 Academic advising

 Professor or department

 Word of mouth/friend/family/etc.

 UO Distance Education home page (http://de.uoregon.edu)

 Schedule of classes

 General Internet search. e.g. Google, Yahoo, AltaVista

 Other (please specify)

Provide a brief statement explaining WHY you want to take THIS course.

Where will you be located during the term?

By submitting this form I agree that I have completed the following:

• I have read and understand the course requirements.
• I understand that I should receive notification on whether my request has been approved within 2-3 business days.
• I understand that submitting this form does not mean that I am automatically approved to register.

Note: Preauthorization requests will not be processed if the 95 student ID number provided does not correspond with the students name and/or the CRN does not match the requested course title. Please take a moment to review your request and make sure all of the information provided is correct.

Upon clicking the Submit button, you should be automatically directed to a new page which includes our contact information. If you are not directed to a new page, then the form was not submitted. If you receive an error message saying you are coming from an unauthorized domain, you are encountering a security application that we must use to prevent malicious use of this form. If you are not directed to a new page or encounter an unauthorized domain error message, please contact Distance Education at (541) 346-4231, (800) 824-2714, or at disted@uoregon.edu for assistance.