Fillable Course Equivalency Form (Dickinson State University)

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Course Equivalency Form (Dickinson State University)

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Registrar’s Office Use: Completed by: ___________________ Date: __________
Course Equivalency Form
This form is used for transfer courses from regionally accredited institutions, other than DSU, that are equal to a
DSU course by approval of the academic department. This course equivalency will be accepted for all current
and future students. Please attach a course description and/or course syllabus of the course from that institution
to this form. Return with original signatures to the Office of Academic Records to update the student’s records for
prerequisites and degree requirements. (Updated 05/07/15)
Student’s Name: _____________________________________________ ID#: __________________________________
Student’s Signature: _______________________________________ Date: _________________________________
TRANSFER COURSE
College:____________________________________________
Course No.:________________________________________
Course Title:_______________________________________
DSU COURSE EQUIVALENT
DSU Course No: ___________________________________
DSU Course Title: _________________________________
______________________________________________________
COMMENTS/ADDITIONAL INFORMATION: ___________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
REQUIRED SIGNATURES:
Student Advisor: _________________________________________________________ Date: ____________________
Department Chair of Major: ____________________________________________ Date: _____________________
Department Chair of Course: ___________________________________________ Date: _____________________
Registrar: _________________________________________________________________ Date: _____________________
Check box if REQUEST IS DENIED/COMMENTS: _________________________________________________
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Course Equivalency Form (Dickinson State University)

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Completed 19 August 2020

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