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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

Date

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

SSN

Approvals:

Advisor/Program Director Date Dean

Date Dean Date

Date

Chairperson Date Office of the Registrar

Name of Student

Date ___ Office of the Registrar ___ Date ___

*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

Initials Registrar Office Date

Please check here if the student is a Veteran

Date