Revised September 1, 2018
Course Substitution Request
Name:
Student
ID #:
Last
First
M.I.
Academic
Department:
Academic
Program:
Substituted Course
Prefix and
Number
Title
Credits
Prefix and
Number
Title
Credits
Institution
(if different
from ISU)
Reason(s) for Substitution(s):
Authorizations
Advisor:
Printed Name
Signature
Department Chair:
Printed Name
Signature
Education Student
Services:
(if educator licensure
program)
Printed Name
Signature
CGPS Dean:
Printed Name
Signature
Scan this form and email to the College of Graduate and Professional Studies, ISU-GradInfo@indstate.edu
. Forms will
only be accepted when emailed from the department or college.
Copy to be retained in ImageNow.