Illinois Central College
Substitution Request for Program Requirements
(Please Print)
Date of Request: ____________________ Student ID ______________________
Student Name: __________________________________________________
Address: _
Phone: ______________________ Email: _______________________________
Applied Science Certificate
Program of Study: ___
Course From: (Institution/Source if other than ICC) ___________________ ___
Substitution Request:
Use Course _____________________________________ Credit hours ___________
For (ICC course): Course ____________________________ Credit hours ___________
Reason: ___
___
___________________________________
Student Signature
Coordinator or Advisor Comments/Recommendations:
___________________________________
Print Name
Catalog of Record_________ ___________________________________
Signature (required) Date
Academic Dean Comments/Recommendation:
___________________________________
Print Name
Approved: ____ Denied ____ ___________________________________
Signature (required) Date
Please Forward to: Graduation, L211
