Request for Course Substitution
Request for Course Substitution
Name
Name
*
First
Last
Student ID
*
Phone
Phone
*
-
###
-
###
####
Email
*
Disability
*
University of New Haven Campus
*
University of New Haven Campus
West Haven, CT
Prato, Italy (Tuscany campus)
Old Lyme, CT
New London, CT
San Francisco, CA
Albuquerque, NM
Course requesting to be substituted
*
Which academic term do you plan to enroll in that course that you are requesting be considered for substitution?
*
Which academic term do you plan to enroll in that course that you are requesting be considered for substitution?
Fall
Spring
Summer
Winter
Year
*
Requests for course substitution should be made a minimum of three weeks prior to the academic term indicated above.
Explain how your disability affects your ability to be successful in the course identified above. If appropriate, state prior history of attempts to complete this course including the effort and/or university support services you utilized.
*
Please sign below after acknowledging the following conditions:
1. I acknowledge that submitting this form to the Accessibility Resources Center does not guarantee approval for the requested course substitution.
2. I understand that the Accessibility Resources Center will contact me at the phone number I have provided above to schedule a meeting with the Director, and I must attend that meeting.
3. I also acknowledge I may be asked to provide additional documentation.
4. I further undertand that I will need to follow all procedures for the process of requesting course substitution.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Date
Date
*
/
MM
/
DD
YYYY