PREREQUISITE OVERRIDE REQUEST
INSTRUCTIONS: Use this form to request permission to register for a course which you do not meet the
prerequisite. Approved requests are good for a single class during the selected quarter only. Both the instructor
and the department lead or division dean must approve the prerequisite override request. Please ll out this
form completely with signatures and return to Hawk Central for registration.
Please note that you may be required to provide appropriate documentation or verication of your previous academic
performance to justify the request for prerequisite override.
TO BE COMPLETED BY THE STUDENT:
Quarter: ❑ Summer ❑ Fall ❑ Winter ❑ Spring Year: __________
Name: _______________________________________ Student ID#: __________________________________
Please write a brief statement supporting your request for prerequisite override for the class listed below:
Class Title: ________________________________________________ Line#: ____________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________________________________ __________________________
Student Signature Date
TO BE COMPLETED BY THE INSTRUCTOR AND DEPARTMENT LEAD/DIVISION DEAN:
Please check the appropriate box, provide comments as appropriate and sign below.
___________________________________________________________________________________________
___________________________________________________________________________________________
(Comments by Instructor - Optional)
_________________________________________________________
Instructor - Printed Name
_________________________________________________________ __________________________
Instructor Signature Date
Prerequisite Override ❑ Approved ❑ Denied
_________________________________________________________
Department Lead or Division - Printed Name
_________________________________________________________ __________________________
Department Lead or Division Dean Signature Date
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the basis of race,
color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status,
or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or
complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all college sponsored events and
programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
