Instructions:
1. The student must obtain form from a Counselor/Faculty Advisor and complete. (A separate form is required for
each course).
2. Student must explain why special permission is requested in space provided, attach additional information and/or
documentation if necessary, sign, date and submit form to a Counselor/Faculty Advisor.
3. The Counselor/Advisor will enter Cumulative G.P.A., Total Hours Completed and return the form to the student.
4. The student will submit the form to the appropriate Instructor. If approved by the Instructor, the student will
submit the form to the appropriate Program Coordinator.
5. The Program Coordinator will review and if approved, will submit to the Vice President of Instruction.
6. If approved, the Vice President of Instruction will return the form to the Office of Admissions for processing.
Semester: ________________ Year: ____________ Major: ____________________________
Name: _____________________________________________ Student ID: _____________________
Phone No. Email Address: ______________________________
Request permission for the following:
_____ Registration in a closed class:
Course: _________________ Section #: ______________ Instructor: ____________________
And/Or
_____ Register/Add class after deadline (Payment due upon approval):
Course: _________________ Section #: _______________ Instructor: ____________________
And/Or
_____ Waive Pre/Co-requisite for a course (TSI requirements CAN NOT be awarded):
Course _________________
Reason for request: (Attach additional information/documentation if applicable)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Student’s Signature Date _________________
TO BE COMPLETED BY:
Cumulative GPA: ____________ Total Hours Completed: ______________
Approved Denied ____________________________________________ _______________
Instructor Date
Approved Denied ____________________________________________ ________________
Division Director/Coordinator Date
Approved Denied _____________________________________________ ________________
Vice President Date
____________________________________________ ________________
Office of Admissions Staff Date
Galveston College is an equal opportunity institution in education and employment. It is the policy of Galveston College to provide equal opportunities without
regard to age, race, color, religion, national origin, gender, disability, genetic information or veteran status.
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