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gree that
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me:
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of the foll
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rom my U
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to be re
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nature:
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nature:
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me: _____
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st to R
e this form
tudent (pl
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ve ALL t
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oved fro
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military c
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Date
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evision v07.10.
r
edit
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ation
w
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page 2
credit as s
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I underst
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_______
17
t
ion(s)
o
f this
pecified
a
nd and
m
ajors.
Revision v07.10.17
Enter information for technical or military transfer courses that you are asking to be
removed from your UA Little Rock academic record. If the courses you list below for
removal have already been applied toward your UA Little Rock major/minor, this form
will be returned to the major/minor area.
Name of Institution Where Credit Was Earned:
(1) (2)
(3) (4)
Institution No. Course No. Course Title:
(above)
Office Use Only:
Degree Audit: Date:
TCA: Date:
Admissions: Date:
Financial Aid: Date:
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