Revalidation of Graduate Course(s) - Form 1
The University of Southern Mississippi
Graduate School
118 College Drive #5024 Hattiesburg MS 39406
This PDF form is fillable. Handwritten copies will not be accepted. Submit completed form via email.
This form is to be completed by the department.
The student listed below is requesting permission to revalidate a graduate level course (or courses) which was completed outside the specified
time limit (5 years for Masters, 6 years for Specialist, and 8 years for Doctoral).
Date:
Student Name (First, Middle, Last): Student ID:
Degree: Emphasis:
Course to Revalidate Semester Enrolled Instructor
Course to Revalidate Semester Enrolled Instructor
Course to Revalidate Semester Enrolled Instructor
Course to Revalidate Semester Enrolled Instructor
Professor to Revalidate Course #1 above:
Professor to Revalidate Course #2 above:
Professor to Revalidate Course #3 above:
Professor to Revalidate Course #4 above:
Upon obtaining signatures, the student will pay $50.00 per course via the "Pay Graduate School Fees" link at www.usm.edu/graduate-
school and return the paid receipt to the Graduate School. The administrating faculty member will notify the Graduate School on the
outcome of the exam (via the Revalidation Verification Form 2), the Graduate School will process the course and grade accordingly.
Signature of Graduate Director/Coordinator: Date:
Signature of Dean of Graduate School: Date:
Updated August 2019
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