COURSE APPROVAL REQUEST FORM

Biomedical Engineering

Please complete this form to the double line below and return to your advisor.

Name:_______________________________ PUID #:________________________
Address:_____________________________________________________________ 
Email:_______________________________ Advisor:________________________
Expected Graduation Date:______________ Today's Date:___________________

I request the following substitutions for the major listed above:

1. _____________________________ to replace_____________________________
2. _____________________________ to replace_____________________________
3. _____________________________ to replace_____________________________

 

Rationale and further explanation:

 

 

 

 

 

 

 

Student Signature: ________________________________________________

 



Special Cases Dispensation: 

Approved Not Approved
Request 1                _________ _________
Request 2                _________ _________
Request 3                _________ _________

 

Signature: _______________________________________ _______________
  Date
Signature: _______________________________________ _______________
  Date

 

Counselor and/or Area Convener Recmmendation:

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Cases Convener Comments:

 

 

 

 

 

 

 

Updated 12/17/13