===== PAGE 1 =====
# 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:___


<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td style='text-align: center; word-wrap: break-word;'>for\nCourse ID and Title</td><td style='text-align: center; word-wrap: break-word;'>for\nKSU Course ID and Title</td><td style='text-align: center; word-wrap: break-word;'>*Verification by D/SA Chair</td></tr><tr><td style='text-align: center; word-wrap: break-word;'>for\nCourse ID and Title</td><td style='text-align: center; word-wrap: break-word;'>KSU Course ID and Title</td><td style='text-align: center; word-wrap: break-word;'>*Verification by D/SA Chair</td></tr><tr><td style='text-align: center; word-wrap: break-word;'>for\nCourse ID and Title</td><td style='text-align: center; word-wrap: break-word;'>KSU Course ID and Title</td><td style='text-align: center; word-wrap: break-word;'>*Verification by D/SA Chair</td></tr></table>

Justification:

Approvals:

Advisor/Program Director

Date

Dean

Date

Chairperson

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

Initials Registrar Office Date