Course Change Request - GRADUATE PROGRAM

STUDENT NAME (Last Name, First Name, MI) *
ENUMBER *
PERSON MAKING REQUEST *
REQUESTOR EMAIL *
DATE DATE * / MM / DD YYYY
COURSES TO BE DROPPED *
CRN: COURSE #: SECTION #: CRN: COURSE #: SECTION #:
COURSES TO BE ADDED *
CRN: COURSE #: SECTION #: CRN: COURSE #: SECTION #:
COURSE INSTRUCTOR(S) TO BE DROPPED *
GRADUATE COORDINATOR SIGNATURE

Draw or Type

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Full Name

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COURSE(S) INSTRUCTOR(S) SIGNATURE

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Full Name

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COURSE(S) INSTRUCTOR(S) SIGNATURE

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
COURSE(S) INSTRUCTOR(S) SIGNATURE

Draw or Type

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Full Name

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DEPARTMENT CHAIR SIGNATURE

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Full Name

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