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!"#$%#&' )'*'#& +,%"-' .,&/0/1#&/,2 3,"4
Graduate Division! / 200 West Kawili St. Hilo, HI 96720-4091! /! COBE! Room 206! /! Phone: (808) 932-7926
Name: ____________________________________________ Student ID: ______________________________
Email: ____________________________________________
Phone! Number: ______________________________
Student Signature: __________________________________________________! Date: ________________________
Current! Semester! (Check! One):! ! Fall! ! Spring! ! Summer! ! Year:! 20!_______ !
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Be aware of any changes in! the course listing, num ber, or alpha
CRN
Course Alpha/No
Credits
@"'6/,%- +,%"-'>-?
List separately! each time! course! was previously! taken
CRN
Course Alpha/No
Credits
5**",6#7 8/92#&%"'-:
We certify that the above course(s) may be repeated:
Primary Advisor Nam e: ________________________________________________
Primary Advisor Signature: ________________________________________________
Date: _____________
Program Chair Name:
Program Chair Signature:
________________________________________________
________________________________________________ Date: _____________
8%;4/& 1,
4*7'&'$ 0,"4 &, &<' !"#$%#&' =/6/-/,2
Graduate C
ouncil Chair: ________________________________________________
Graduate Council Chair Signature: ________________________________________________ Date: _____________
FOR GRAD! DIVISION! OFFICE USE ONLY:
SPACMNT STAR!
Rev. 01/2017