_____________________________________________________________
I,
______________________________________, certify that I am taking the above course
on a pass/fail basis.
______________________________________________ __________________________
Student Signature Date
____________ ____________________ ________________ ________________________
Advisor Signature Date
Office use only
Jefferson Community College
Pass/Fail Option Registration
Form
Spring 2020
This form must be emailed to tfinch@sunyjefferson.edu and copied to
ademiceli@sunyjefferson.edu by April 21, 2020.
No more than two (2) courses may be designated pass/fail in the Spring
2020 semester.
Student J Number: _____________________________________________________________
Student Name: _____________________________________________________________
Address: _____________________________________________________________
Course:
Course:
CRN:
CRN:
Instructor:
Instructor:
Date Entered:
cc: Instructor
isw:03/2020
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