White – Records and Registration Yellow – Department Pink - Student REG 11/16
Course Substitution Request
Student should consult with their Academic Advisor
Student submits Course Substitution Request form to Program Chairperson for review and evaluation
Program Chairperson forwards Course Substitution Request to their Division Dean for final approval
If approved, the Division Dean forwards this form to the Records and Registration Office for processing
Course substitution will appear on the students Program Evaluation (check Web Advisor)
Please Print:
Last Name ___________________________________First Name ___________________________________________
CCM ID # ____________________
Major#/Major Name _______________________________________ Anticipated Month/Year of Graduation __________
IMPORTANT: Do not assume that course substitutions approved by CCM will be accepted as transferrable credit to another
institution or will apply to a different CCM program. Transferability should be checked with each institution.
Student Signature _______________________________________________________________ Date _____________
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Department Approval
Not
Recommended
Not
Recommended
Approved
Dept. Notes/Explanation: _________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
***Division Dean return this form to Records and Registration for processing***
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Records and Registration
Rec and Reg Input _______________ Date __________________________
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