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, Hart, Mobbs,
or Putnam (CC and GS Psychology Program Advisors) or Profs. Champagne and Curley (CC & GS Neuroscience & Behavior Program Advisors)
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 Paulo Ribeiro and Prof. Lois Putnam. It was last modified by pr2454 on September 15, 2014.