This form must be
filed with the Registration Center, Derryberry Hall 121, and a duplicate copy must be filed with the College of Graduate School.
Updated 5.25.16 bc
Student Information:
Student Name: _________________________________________ T#: __________________ Date: _________
(Last) (First) (MI)
Courses Requested:
If approved, this course(s) will give me a total class load of _____ hours for the above term.
CRN SUBJ COURSE # TITLE
CREDIT HOURS
Please check the one option below that applies to you:
___ I certify that I am classified as a senior and my cumulative GPA is _____. I understand that I will receive
UNDERGRADUATE credit for this course, and I cannot later receive graduate credit for it.
(Senior: overall GPA
3.0 or higher required, limited to 9 hours of graduate coursework while still pursuing an undergraduate degree.)
___ I certify that I am within 18 hours of completing the requirements for the Bachelor’s Degree and my cumulative
GPA is _____. I understand that I will receive GRADUATE credit for this course, and I cannot later receive
undergraduate credit for it. I understand that this credit will not automatically count toward a graduate degree.
(Senior: overall GPA 3.0 or higher required, limited to 9 hours of graduate coursework while still pursuing an undergraduate degree.)
___
I certify that I am classified as a U
ndergraduate Non-Degree seeking student. I understand that I will receive
___ UNDERGRADUATE credit for this course, and I cannot later change the application of this credit.
*This option is recommended for teacher certification courses.
Student Signature: ___________________________________________ Date: ___________________
Approval Signatures:
Department Chair: __________________________________________ Date: ___________________
Advisor: _____________________________________________ Date: ___________________
Instructor: _____________________________________________ Date: ___________________
College of Graduate Studies: ___________________________________ Date: ___________________
Request for Undergraduate or Graduate Credit
