KENTUCKY STATE UNIVERSITY OFFICE OF THE REGISTRAR PHONE: 502-597-6340 FAX: 502-597-6239

Request for Course Substitution Form

##

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
Name of Student

Date ___ Office of the Registrar ___ Date ___

<div style="text-align: center;"><img src="imgs/img_in_image_box_7_15_374_71.jpg" alt="Image" width="98%" /></div>

*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