Department of Psychology
Major Requirement Substitution Form

to be filed in student's docket (in 406 Sch) and entered in student's DAR

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: ________________________________ ____________________________

Number and name of substitute course:________________________________________________________

Taken where? _____________________________________ Taken when?___________ Grade rec'd______

How many points of transfer credit were awarded by CC or GS? ________________

I am providing my Program Advisor with the following materials: ___syllabus showing lecture topics and reading assignments; __course description; __transcript; __CC or GS transfer credit report; __textbook; __exams; __papers

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.

This is to certify that, for the student named above, the course described above may be substituted for the following course/requirement in the Dept of Psychology: _________________________________ ____________________ and should count for ________ credits.

If this is a conditional approval, any conditions that must be fulfilled are checked:

__ grade received must be C- or better (for courses taken at Columbia University)
__ grade received must be B- or better (for courses taken elsewhere)
__ approval must be obtained from the following faculty member:
__ the Program Advisor needs to see the following materials:

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)


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.