Fillable UH-H MOD FORM 8.18.08 RevisedModification Ff - Revised Modification Form 1

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UH-H MOD FORM 8.18.08 RevisedModification Ff - Revised Modification Form 1

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Date Received by Office of the Registrar:__________ STAR Advisor Notes w/email sent: ___________ By:_____________ rev 07/08
University of Hawai`i at Hilo
REQUEST FOR MODIFICATION OF ACADEMIC REQUIREMENTS
(Undergraduate)
Student Name:____________________________________________ Student ID #:_______________________
Expected Graduation Semester:________________________ Email Address: ___________________@hawaii.edu
Major/Minor/Certificate:_________________________________________________________________________
(Include option(s), concentration and/or emphasis as appropriate)
SUBSTITUTION:
**Approved:
Major Minor Cert *GE *Other Course/Grade/Institution UHH Course/Requirement YES NO
□ □ □ □ □ ________________________________________ for ____________________ □ □
□ □ □ □ □ ________________________________________ for ____________________ □ □
□ □ □ □ □ ________________________________________ for ____________________ □ □
□ □ □ □ □ ________________________________________ for ____________________ □ □
WAIVER:
**Approved:
Major Minor Cert *GE *Other Specify Requirement: # of Credits YES NO
□ □ □ □ □ ______________________________________________________ _______ □ □
□ □ □ □ □ ______________________________________________________ _______ □ □
□ □ □ □ □ ______________________________________________________ _______ □ □
JUSTIFICATION:
UH Hilo Catalog Year: ________________ Page(s) the requirement(s) is/are listed on:___________________________
Supporting Documentation (use back of form if needed):____________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
APPROVALS: Print Name Signature Date
Faculty Advisor : ___________________________________ __________________________________ ___________
** If modifying multiple degree requirements, approval is needed for each program area.
Program/Dept Chair:
_________________________________ _________________________________ ___________
Major □ Minor □ Cert □
Program/Dept Chair:
_________________________________ _________________________________ ___________
Major
□ Minor □ Cert □
Program/Dept Chair:__________________________________ _________________________________ ___________
Major
□ Minor □ Cert □
*College Dean:______________________________________ __________________________________ ___________
General Education
□ Other Requirements □
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UH-H MOD FORM 8.18.08 RevisedModification Ff - Revised Modification Form 1

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Completed 10 February 2020

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