Course Number Title Weight of Course Term(s)
Half Full FallWinterSummer
Half Full FallWinterSummer
Note:Coursesnotrequiredforthestudent'sdegree,aswellas"audit"coursesarenottobetakenunderthisPlan.Ifthe
requestedcourseisavailableatWestern,thiscoursemustbenotedbelow:
WesternCourseNumberandTitle:
Student'sSignature*:___________________________________________ Date_________________ __
*I hereby request permission to take the graduate course(s) which are required for my degree program, indicated
above, at the host university and understand the requirements and deadlines under the OVGS program.
Section 2: Graduate Chair/Coordinator of Home and Host University
Inapprovingthisapplicatio n,theWesterngraduateprogramcertifiesthatthestudent:
Ispursuingagraduatedegreeasindicatedontheform;
IsingoodstandingatWestern;
Requiresthecourse(s)specified;
Willreceivecoursecreditforthecourse(providingsuitablestandingisobtained).
Inapprovingthisappl
icatio
ntheHostgraduateschoolcertifiesthat:
Thecourse(s)specifiedwillbeofferedduringtheterm(s)asindicatedabove;
Thestudentwillbeassuredaspaceinthecourse;
Thestudentwillbeidentifiedasavisitinggraduatestudent.
Approvals (must be obtained in this order)
1)WesternUniversityGraduateChair/Coordinator(signandprintname)Date
2)WesternUniversityGraduateVice‐Provost(signandprintname) Date
3)HostUniversityDepartmentChair/Coordinator(signandprintname) Date
4)HostUniversityGraduateDean(signandprintname) Date
Onsigningapproval,theHostUniversitymustsendacopytoWesternattheaddressbelow.Afterthestudenthas
enrolledandafterthetermenrolmentreportdate,theHostUniversityAccountsOfficeisrequestedtosendaninvoice
to:Western University, Western Student Services Building, Room 2140 (attn: OVGS), London, ON N6A 3K7.
ThepersonalinformationonthisformiscollectedundertheauthorityoftheUniversityofWesternOntarioAct,1982,asamended.
ForacompleteCollectionNotice,visitwww.uwo.ca/grad.
FormrevisedFebruary2016
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