Request For Course Waiver/substitution Liberal Arts Program Form - 2012

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HONOLULU COMMUNITY COLLEGE

REQUEST FOR COURSE WAIVER/SUBSTITUTION

LIBERAL ARTS PROGRAM

INSTRUCTIONS FOR THE STUDENT

To The Student: (1) You must consult with a counselor before submitting this Request for Course Waiver/Substitution form. (2) For a transfer course

used as a course substitute, a course description must be attached to this form. (3) An official transcript other than the University of Hawaii System must

also be sent to HonCC Records Office when the course is successfully completed. Only courses taken at a regionally accredited institution, military

training evaluated by the American Council on Education, or recognized foreign institution may be considered. (4) Complete this form and submit it to

the counselor.

Student Name:_____________________________________________

Banner ID :________________________

Print Last Name, First Name

Address:_________________________________________________________________________________________

Street

City

State

Zip Code

Major:____________________Option (if any):________________________ Degree :_____________

COURSE ALPHA/No

CRS

COURSE TITLE

GRADE

SEMESTER

HONCC COURSE TO WAIVE:

__________________

____

_____________________________________

COURSE TO SUBSTITUTE:

__________________

____

_____________________________________

_______

___________

__________________

____

_____________________________________

_______

___________

COLLEGE COURSE TAKEN AT: __________________________________________________________

OFFICIAL TRANSCRIPT IN? YES/NO

REASON FOR THIS REQUEST:_______________________________________________________________________________________________

I understand that my HonCC advising document and transfer transcript(s) will be reviewed by the Division Chair, and the Dean of the Program

for recommendation/approval of the Request of Course Waiver/Substitution. I have discussed this request and its effect on my academic

program with the counselor.

Student’s Signature:_________________________________________________Date: ___________________________

Counselor’s Name/Signature:__________________________________________Date: _________Logged:___________

-------------------------------------------------------------------

TO BE COMPLETED BY

 approved

 disapproved

LBRT Program Coordinator:

I recommend this request be:

Reason:_______________________________________________________________________________________

Print Name:________________________Signature:____________________________________Date: ___________

------------------------------------------------------------------------------------------------------------------------------------------------------------------

 approved

 disapproved

Division Chair (student’s major):

I recommend this request be:

Reason:_______________________________________________________________________________________

Print Name:________________________Signature:____________________________________Date: ___________

------------------------------------------------------------------------------------------------------------------------------------------------------------------

 approved

 disapproved

Dean of Program (student’s major):

This request has been:

Reason:_______________________________________________________________________________________

Print Name:_________________________Signature:___________________________________Date: ___________

-------------------------------------------------------------------- TO BE SUBMITTED TO ABOVE COUNSELOR ---------------------------------------------------------------------

_______________ Date and Counselor’s Initial

_______________ Date Entered Banner

_______________ Credits Transferred (if applicable)

_______________ Date Notified Student

Draft

Revised 2/24/12