KENTUCKY STATE UNIVERSITY OFFICE OF THE REGISTRAR PHONE: 502-597-6340 FAX: 502-597-6239
Request for Course Substitution Form
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Date Name of Student
___ SSN
Major Area
This is a request to substitute the following courses:
Institution where courses were taken if other than KSU:___
for Course ID and Title for KSU Course ID and Title *Verification by D/SA Chair
Major Area
Verification by D/SA Chair
Verification by D/SA Chair
Verification by D/SA Chair
Date
Date
Date
for Course ID and Title KSU Course ID and Title *Verification by D/SA Chair
for Course ID and Title KSU Course ID and Title *Verification by D/SA Chair
Justification:
Justification [1]
Justification [2]
Justification [3]
Institution where courses were taken if other than KSU [1]
Initials Registrar Office
Dean
Office of the Registrar
KSU Course ID and Title
KSU Course ID and Title
KSU Course ID and Title
SSN
Approvals:
Advisor/Program Director Date Dean
Date Dean Date
Date
Date
Chairperson Date Office of the Registrar
Name of Student
Date ___ Office of the Registrar ___ Date ___
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*Verification by Discipline/Subject Area Chair is required only when substituting a course of your discipline.
Please check here if the student is a Veteran.
Forward copy to Veteran Affairs Coordinator, Forward by: ___ Initials Registrar Office Date
Advisor/Program Director
Chairperson
Institution where courses were taken if other than KSU [2]
Course ID and Title
Course ID and Title
Initials Registrar Office Date
Please check here if the student is a Veteran
Date