Registrar’s Office Use: Completed by: ___________________ Date: __________
Course Substitution – Waiver Permit
This form is used for any courses from regionally accredited institutions, including DSU, that are not considered equal
to a DSU course, but are an acceptable substitution for the student’s degree requirements. This course substitution
applies only to this student. A course required in the major/minor/concentration may not be used as a substitute
for another required course in that program. Substitutions do not satisfy pre-requisite requirements.
(Updated 05-07-15)
1. Take form to advisor along with course syllabi and/or other necessary materials (if needed).
2. Advisor will complete the course information and rationale(s), and then sign the form.
3. The department chair’s signature is required for all substitutions.
4. The department will return form to the Office of Academic Records for notation in the student’s Academic
Advisement Report.
Student’s Name: ________________________________ Student ID#: _____________________ Date: ____________________________
Substitution in: Major / Minor / Concentration (circle one) & list area: ___________________________________________
Have you applied for graduation? Yes or No (circle one) If yes, for what semester?_______________ Year?_________
Permission to substitute:
College:___________________________________________________
Course Prefix:_______________ Course No.:_______________
Course Title:______________________________________________
Credit Hours: ___________ Semester Taken: _____________
May be substituted for or waived at DSU:
DSU Course Prefix & No: _____________________________
DSU Course Title: _____________________________________
Credit Hours: ___________
Rationale for substitution/waiver: ________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
REQUIRED SIGNATURES:
Student Advisor: _________________________________________________________ Date: ____________________
Department Chair of Major: ____________________________________________ Date: _____________________
Chair of Course (Gen. Ed Sub. Only): ____________________________________ Date: _____________________
Registrar: _________________________________________________________________ Date: _____________________
Check box if REQUEST IS DENIED/COMMENTS: _________________________________________________
