Revised: 10/26/16
COURSE SUBSTITUTION FORM
Student Name ____________________________________________________ ID/SSN #
(Please print all information) Last First MI
Major/Minor ______________________________ Degree/Cert ______________ Catalog Year
LCSC Course Substitution (for major/minor requirements)
LCSC Course Taken:
Substitute for LCSC Course:
Subj
No
Cr
Term
Title
Subj
No
Cr
THIS SUBSTITUTION IS VALID ONLY FOR THE MAJOR/MINOR LISTED ABOVE
Advisor Name (printed)_______________________________ Signature _____________________________ Date ________
Division Chair Name (printed)__________________________ Signature _____________________________Date _________
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