Fillable Request For Permission To Take Courses Off Campus Fall Winter F 2010 Input (Southern College)

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Request For Permission To Take Courses Off Campus Fall Winter F 2010 Input (Southern College)

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REQUESTFORPERMISSIONTOTAKECOURSESOFFCAMPUS
Fall/WinterSemester
INSTRUCTIONS
• Aftercompletionoftheform,obtaintherequiredsignaturesintheordergivenbelowifyourespond“yes.”
• Attachthecoursedescriptionfromtheinstitutionyouareplanningtoattendforeachclassyouare
planningtotakeoffcampus.
• Pleasereturnthisformandtheattached
coursedescription(s)inpersonorviafax(423.236.1899)to
RecordsandAdvisement.
POLICIESGOVERNINGTRANSFERCREDIT
• Amaximumof72semesterhoursmaybetakenatacommunitycollege.
• Thelast30ofthelast36semesterhoursmustbeearnedinresidenceatSouthern.
A.APPLICATIONDATA
ID#:NAME:______________________________________________DATE:____________________
EMAIL:CONTACTPHONE:______________________________
MAJOR(S):GRADUATIONDATE:______________________
REASONFORREQUEST:_____________________________________________________________________________________
____________________________________________________________________________________________________________
B.INSTITUTIONDATA
Nameandcompleteaddressoftheinstitutionyouplantoattend:
______________________________________
______________________________________
______________________________________
●Thecollegeyouplantoattendis(checkone):
Two‐yearaccreditedORFour‐yearaccredited
●Termofenrollmentis(checkone):
FallsemesterWintersemesterOR

1
st
quarter2
nd
quarter3
rd
quarter
Pleaseprovidethecourseprefixes,coursenumbers,coursetitlesandthenumberofsemesterorquarterhoursfortheclasses listed
belowfromtheschoolyouareplanningtoattend.
CoursePrefix&Course#
(Donotusesynonymnumber)
CourseTitle
(attheschoolwhereyouwillbetakingtheclass(es))
No. ofCreditHours
SemesterORQuarter
Example:HIST174 WorldCivilizations

3OR_______

_______OR________

_______OR________

_______OR________
C.APPROVALSIGNATURES
Pleaseobtainsignaturesintheordergivenifyourespond“yes”tothequestionslistedbelow.
1. Areyourequestingtotakemorethanoneclassoffcampusduringtheschoolyear?YesNo
SignatureofFinancialAidCounselor:_______________________________________________________
2. Areyourequestingtotakeamajor,
minor,cognate,orpre‐professionalprogramclass?YesNo
SignatureofChair/DeanofDepartment/School:_______________________________________________
3. WillyoubetakingclassesatSouthernandoffcampusduringthesamesemester?YesNo
SignatureofAssociateVPforAcademicAdministration:_______________________________________
4. Doyouhavelessthan30semesterhoursleftforgraduation?If“yes,”
howmanyhours?____________YesNo
SignatureofAssociateVPforAcademicAdministration:_______________________________________
5. AreyouastudentwithaF‐1orJ‐1visa?YesNo
SignatureofInternationalStudentAdviser:___________________________________________________
Pleaseindicateaction(ifany)neededbyRecordsandAdvisement:
MailaletterofgoodstandingtotheschoolIplantoattend.(Nameandcompleteaddressarelistedabove.)
Mailaletterofgoodstandingtomeatmycurrentaddress:_____________________________________________________________
FaxaletterofgoodstandingtotheschoolIplantoattend.Youmustsupply
thefaxnumber:_______________________________
Noactionneeded.Pleasecontactmebytheselectedcontactoptiontoletmeknowregardingapproval(checkone):
emailORcontactphonenumber
FORRECORDSANDADVISEMENT USEONLY
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Request For Permission To Take Courses Off Campus Fall Winter F 2010 Input (Southern College)

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Completed 23 July 2020

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