Fillable (For Undergraduate Programs) SECTION I: Student Information (University of Hawaii at Hilo)

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(For Undergraduate Programs) SECTION I: Student Information (University of Hawaii at Hilo)

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Revised 09/2016
Office of the Registrar / 200 West Kawili St. Hilo, HI 96720-4091 / Student Services Building, First Floor Rm E-101 / Phone: (808) 932-7447 / Fax: (808) 932-7448 / E-mail: uhhro@hawaii.edu
SECTION I: Student Information
Student Name: _____________________________________________________ Student ID: ________________________
Email: _________________________________________@hawaii.edu Phone: ____________________________
Expected Graduation Semester: _______________________________________
Major/Minor/Certificate Modifying**: _______________________________________________________________________
(Include option(s), concentration and/or emphasis as appropriate)
Student Signature: ____________________________________________________________ Date: ___________________________________
SECTION II: Course Information
Course Substitution:
Major Minor Cert *GE *Other Course/Credit/Institution/Semester & Year UHH Course/Requirement
__________________________________________ for __________________________
__________________________________________ for __________________________
__________________________________________ for __________________________
__________________________________________ for __________________________
Course Waiver:
Major Minor Cert *GE *Other Specify Requirement # of Credits
_________________________________________________________ _____________
_________________________________________________________ _____________
_________________________________________________________ _____________
Course Justification:
__________________________________________________________________________________________
__________________________________________________________________________________________
SECTION III: Approvals Print Name Signature Date
Faculty Advisor: _____________________________________ _____________________________________ ________________
Program/Dept. Chair: _____________________________________ _____________________________________ ________________
Major Minor Cert
**If modifying multiple degree requirements, approval is needed for each program area.
Program/Dept. Chair: _____________________________________ _____________________________________ ________________
Major Minor Cert
Program/Dept. Chair: _____________________________________ _____________________________________ ________________
Major Minor Cert
*If modifying General Education or other Graduation Requirements, approval is needed from the Dean.
• Approval is needed from the Writing Intensive Coordinator to modify a course for the Writing Intensive (WI) requirement.
WI Coordinator: ____________________________________ ____________________________________ ________________
College Dean: ____________________________________ _____________________________________ ________________
General Education Other Graduation Requirements
FOR OFFICE OF THE REGISTRAR USE ONLY:
SHADGMQ ____ ___ VA *STAR NOTE* Date: ______ ___ Initials: ______________
*Email Sent
REQUEST FOR MODIFICATION OF ACADEMIC REQUIREMENTS
(For Undergraduate Programs)
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(For Undergraduate Programs) SECTION I: Student Information (University of Hawaii at Hilo)

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Completed 29 August 2020

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