Doc = Override-Offline Form

OFF-LINE (OVERRIDE)/SPECIAL PERMISSION FORM DEPARTMENT OF COMMUNICATION DISORDERS

Section I: To be completed by student Date:

Check One: Student’s Name: Graduate: ______Undergraduate: ______Non-Degree: ______Telephone # in case of problems: ______Grading Basis: E-Mail Address: Pass/Fail ______Letter Grade ______

Eight Digit Student SPIRE Number:

Name & Number of Course Student Wishes to Add: Semester: ___ Fall 20 ___ (example: Comm-Dis 496) NOTE: TA’s DO NOT put the ___ Spring 20 ___ class you are TA’ing for, you put the instructor Independent Study number down for their section:

Comm-Dis ______

Course's 5 digit Class/Schedule Number: Number Of Units/Credits: (example: 12075)

NOTE: For School of Public Health & Health Sciences, if this course addition will take student over 19 credits (an overload of credits MUST be done prior to giving this form to Joy for processing). For other Non-Major students, please see YOUR Academic Dean!

Student's signature:

Section II: To be completed by faculty/instructor Date: FACULTY/INSTRUCTOR: PLEASE DO NOT SIGN BELOW UNLESS ALL INFORMATION ABOVE IS VERIFIED (NUMBER OF CREDITS, PASS/FAIL, CLASS SCHED. NUMBER, ETC.)

The above named student has my permission to add my course.

______Instructor/Faculty Signature

Processed By: ______Date: Joy Holhut, Office Mgr. Doc = Override-Offline form