SPECIAL EXCEPTION(S) FOR GRADUATION REQUIREMENTS

THESE SUBSTITUTIONS ARE VALID ONLY FOR CERTIFICATES OR ASSOCIATE DEGREES AWARDED BY THE UNIVERSITY OF PITTSBURGH AT TITUSVILLE

I (please print your name)                                                                                   wish to apply for the following substitution(s) for completion of a

(please check one)                  certificate   or                associate degree.

Name of Certificate or Associate Degree: _________________________________________________

I have other substitution(s) already approved  (circle one)  YES NO     Anticipated graduation date:                                           

I understand that this(these) substitution(s) is(are) void if required course(s) is(are) offered prior to completion of my certificate/associate degree.

Student's signature                                                                                Date                                      

Student's ID number                                   Student's Social Security # __________________

Advisor's signature                                                                                Date                                      

Signature of academic dean                                                                Date                                      

Completed form must be turned in to the Office of the Registrar, Bennett Davis Hall, Room 112,  phone 814-827-4482, fax 814.827.5405.