COURSE SUBSTITUTION AND WAIVER FORM
The College at Brockport
State University of New York
350 New Campus Drive
Brockport, New York 14420-2966
Office of Registration and Records
NAME: BANNER ID #
ADDRESS: CITY STATE ZIP
THIS SECTION MUST BE COMPLETED:
Major: Concentration: Minor:
1. Original Brockport Course Requirement:
Subject Code Number Title
Course Substitution:
Subject Code Number Title Completed at:
2. Course Requirement Waiver:
Subject Code Number Title
Student must complete credit hours in major/minor.
3. Signatures:
ADVISOR: DATE:
DEPARTMENT CHAIR: DATE:
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