Petition for Course Substitution Form

Southern Polytechnic State University Petition to the Faculty Course Substitution
Name: ________________________________________________________________________
Street Address: _________________________________________________________________
City: _____________________________ State: ______________ Zip Code: ________________
Home Phone: _________________ Work Phone: _________________ Email: ________________
SSN: _____________________ Date: ___________________ Major: _____________________
___ Undergraduate or ___ Graduate ........ Graduation Catalog Year: ______________
Can we contact you at work? ___Yes ___No

For the purpose of graduation, I respectfully petition the Faculty of SPSU for permission to substitute:
Catalog Number and Name: ______________________________ completed in (qtr/yr): __________
at (college/university): ________________________________________________________
SPSU's Catalog Number and Name: _____________________________________________
for the following reason(s): ________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

I understand that I must obtain the signature of my major department head prior to submitting this petition to the Registrar's Office. Furthermore, if I am requesting a course substitution for a required course taught outside my major department, I realize I need to obtain the course department head's signature before I obtain the signature of my department head.
Finally, I will not assume this petition will be approved because of a department head's recommendation in my favor. I realize any action on my request is not complete until the committee's recommendations are acted on by the general faculty.
Petitioner's Signature: __________________________________________________________

Required for Course Taught Outside Your Major Department __ Recommended or __ Not Recommended
Comments: ______________________________________________________________________
_________________________________________________________________________________
Course Department Head's Signature: ______________________________________________

__ Recommended or __ Not Recommended
Comments: ______________________________________________________________________
_________________________________________________________________________________
Major Department Head's Signature: ______________________________________________

For Office Use Only
__ Recommended or __ Not Recommended
Acted on by: __ Committee or __ Registrar's Office or __ Academic Affairs
Comments: ______________________________________________________________________
_________________________________________________________________________________
Registrar's Representative: __________________________________________ Date: ___________