For office use only
Electronic signature verified by: _________________ Processed by: _____________ Date __________________
Revised 10/21/2019 Purple
Course Substitution Request
LFCC Records / Office of the Registrar · 173 Skirmisher Ln · Middletown, VA 22645
Telephone: 540-868-7105 Email: records@lfcc.edu Fax: 540-868-7005
PART I: (Completed by student)
Student ID# Date of birth
Name
Last First Middle
Email @email.vccs.edu Phone
PART II: (Completed by student and advisor) ALL FIELDS MUST BE COMPLETED
I request that the following course substitutions be approved to fulfill the requirements of the academic plan indicated below. I understand that
this substitution does not guarantee the future transferability of any course to any other college or university. It is my responsibility to determine
transfer acceptance if desired.
My LFCC academic plan is:
*ADVISEMENT REPORT MUST BE ATTACHED TO COMPLETE PROCESSING*
Student Signature: Date:
I voluntarily consent to the use of an electronic record of my LFCC student file. I acknowledge that, by logging into the MYLFCC system with my unique credentials and e-
mailing from my @email.vccs.edu account to provide LFCC with this data, I have given my electronic signature which has the same legal and binding effect as a "wet" or
handwritten signature.
Justification:
Advisor name (printed) Advisor signature Date
PART III: (Completed by Academic Dean or AVP)
Faculty signature (if applicable) Date Academic Dean/AVP’s signature Date
Student notified: Initials Date
If not approved, provide reason:
