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Student : Read Instructions then complete top part of this form and bring it, along with syllabus and other course materials, to your Program Advisor*. If permission is granted, it is your responsibility to deliver copies of the signed form to the appropriate offices, including the Undergraduate Curriculum Assistant in 406 Schermerhorn Hall. Name_______________________________________ Class________________ Date ____________ UNI ______________ other email addr _________________________Declared major when? ______ Campus Address _______________________________________ (phone)____________________ Home Address _________________________________________ (phone)____________________ I am applying to have
the course described in the box below accepted as a substitute for the
following CU Psych Dept Course or major/concentration requirement: ________________________________ ____________________________
I think this substitution is justified because (check all that apply): ( ) The course I took is comparable to one offered in the Columbia Psych Dept; ( ) I have the syllabus and other materials to show this; ( ) I took the course less than 8 years ago; ( ) I took the course before transferring here; ( ) I received a grade of B- or better; ( ) other justifications (use back if necessary): Program Advisor completes bottom part of form.If this is a conditional approval, any conditions that must be fulfilled are checked:
Approved by ______________________________________________ on (date) ________________ Must be signed by one of the following
*Program Advisors: Profs. Lindemann, Sparrow, Mobbs,
or Putnam (CC and GS Psychology Program Advisors) or Profs. Hood and Hart (CC & GS Neuroscience & Behavior Program Advisors)
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Student: When you print this form, please be sure that it fits on one page. Click here to download a single-page pdf file.
This page is maintained by Andres Torres and Prof. Lois Putnam. It was last modified by aft2109 on July 23, 2012.