You must submit this form after you have begin your course registration for Performance Based Pathway Courses. After this form is received and approved, the fee will be waived from the course registration that you have already started.

Employee Name

Employee A#

Employee IIT Email Address

Email address used to create the Coursera Registration account, if different than the IIT email address

Is this request for you or a dependent?

What is the relationship?

What is their date of birth?

Dependent First Name

Dependent Last Name

What program do you wish to pursue?

For which courses do you intend to register?

ITM 701 - Introduction to Contemporary Operating Systems and Hardware 1AITM 702 - Introduction to Contemporary Operating Systems and Hardware 1BITM 703 - Introduction to Contemporary Operating Systems and Hardware 1CConditional by program - can choose up to three

For which courses do you intend to register?

MBA 701 - Competitive StrategyMBA 702 - Managerial Economics: Buyer and Seller BehaviorMBA 703 - Mastering Excel Essentials to Enhance Business ValueConditional by program - can choose up to three

For which courses do you intend to register?

CS 725 - Introduction to Relational DatabasesCS 726 - Relational Database DesignCS 727 - Relational Database Implementation and ApplicationMATH 764 - Linear RegressionMATH 765 - Model Diagnostics and RemedialMATH 766 - Nonlinear RegressionConditional by program - can choose up to three

For which courses do you intend to register?

ITM 705 - Hardware and Operating System Foundations IITM 706 - Hardware and Operating System Foundations IIITM 707 - Hardware and Operating System Foundations IIIConditional by program - can choose up to three

For which courses do you intend to register?

Business Economics and Game Theory for Decision-Making - MBA 707Innovation and International Strategy - MBA 706A Comprehensive Excel Masterclass: Unleashing Business Potential - MBA- 708Variable Selection, Model Validation, and Nonlinear Regression - MATH 766Relational Database Implementation and Applications - CS 727Programming and Application Foundations - ITMD 504Introduction to Data Networks and the Internet - ITMO 540Introduction to Open-Source Application Development - ITM 313Introduction to Data Networks and the Internet - ITMO 340Conditional by program - can choose up to three

Supervisor Name

Supervisor IIT Email Address