
 

C
losed
C
lass
O
verride Card
 





Stu
d
ent ID Num
b
er
Stu
d
ent Name (Last, F
i
rst)
Stu
d
ent S
ig
nature
C
o
urse Num
b
er
Aut
ho
ri
z
e
d
A
d
ministrat
o
r (Print Name/Signature)
C
o
urse Instru
c
t
o
r (Print Name/Signature)
Tit
l
e
Department
Department
Date Signe
d
Date Signe
d
C
o
urse Num
b
er
C
o
urse Instru
c
t
o
r (Print Name/Signature)
Department
Date Signe
d
Aut
ho
ri
z
e
d
A
d
ministrat
o
r (Print Name/Signature)
Tit
l
e
Department
Date Signe
d
Date S
ig
ne
d
Term
A&R Card – Created 3/2020
For Office Use Only
Processed by (Print Name)
Processed by (Signature)
Campus/Location
D
a
te Signed
Select One
Hialeah Campus
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit