Admissions & Records
1/7/2015
Petition for Course Substitution
Course substitution for: Associate Degree
Certificate of Recognition
Certificate of Achievement
Title of Degree or Certificate_______________________________________________
Applicable Catalog Year_____________ Student ID #______________________
Print Student Name_____________________________________________________
Student contact information i.e. phone #_____________ e-mail___________________
Please provide an explanation to justify this substitution, and attach appropriate
documentation from the instructor:
Required course: Substituted course:
____________________________ __________________________
Student Signature__________________________________ Date_________
Instructor Signature_______________________________ Date_________
Print Instructor Name______________________________
Dean Signature____________________________________ Date_________
Print Dean Name__________________________________
OFFICE USE ONLY
A&R Rec’d Date _________
Initials__________________
(Check for all signatures)
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