Mailing Address: Street
City
State
Zip
Daytime Phone
Evening Phone
Email address
Please note that if the demand for a course exceeds the course
capacity, a random selection pre-registration process will be used to determine
which students will be allowed to enroll in each course.
The following distance education courses are offered in the Spring 1999 Semester:
- Respiratory Pharmacotherapy, 728-720, 1 credit (DE: February
1 - 26)-R
- Gastrointestinal Pharmacotherapy, 728-722, 1 credit (DE: March
1 - 26)-R
- Immunology Pharmacotherapy, 728-725, 1 credit (DE: April 5 -
30)-R
- Communication Issues for the Practicing Pharmacist, 728-490,
2 credits (DE: January19 - May 17)-R
- Geriatric Pharmacotherapy, 728-710, 2 credits (DE: January 19
- March 19)- E
DE = Distance Education // R = Required // E = Elective
1. Distance Education Preferred Courses
Indicate ALL of the distance education courses that you
would like to take in Spring Semester 1999 by scrolling through the courses
listed for each rank and selecting the courses that you would like to take.
The phrase "no course selected" will indicate that you do not want to take
a course at that particular rank. (For instance, if you want to take 3 courses
during Spring Semester 1999, select courses for Ranks 1, 2, and 3 and list
the phrase "no course selected" at Ranks 4 and 5.) Please rank your courses
in the order in which they are most important to you. Use Rank 1 for the course
that is most important to you, Rank 2 for the course that is second-most important
to you, etc.
If space is available, I would like to enroll in ALL of the following
distance education courses for Spring Semester 1999:
Rank.....Preferred Spring 1999 Courses
Rank 1.
Most Important
Rank 2.
Rank 3.
Rank 4.
Rank 5.
Least Important
2. Substitute Courses
Indicate below which distance education course(s) would be acceptable to
you as substitute(s) if any of the distance education courses selected above
are not available. Scroll through the courses listed at each substitute rank
and select your desired substitute course for that particular rank. The phrase
"no course selected" will indicate that you do not want to list a substitute
course at that particular rank.
If any of my preferred courses are not available, I will accept
the following distance education courses as substitutes:
Rank......Substitute Spring 1999 Courses
Substitute Course 1.
Most Important
Substitute Course 2.
Substitute Course 3.
Substitute Course 4.
Least Important
3. Please indicate in the field provided the maximum number
of didactic course credits that you want to take via distance eduction during
the Spring1999 Semester
. (Do not include clerkship course credits in this number.) We will not assign
you any more didactic course credits than the maximum number indicated.
4. If you do not want to take a Spring1999 course, please check the box
below:
I do not want to enroll in any Spring 1999 courses.
We recommend that you print a copy of your completed
form prior to submitting it electronically.
Selections must be submitted electronically no later than November
24, 1998. If you have any questions, contact Pam Palmer, (608)262-6234, papalmer@pharmacy.wisc.edu
or Bob Breslow (608)262-5365, rmbreslow@pharmacy.wisc.edu