Name: ________________________________________ Date: ____________________

Address: ____________________________________________________________________

____________________________________________________________________________

Division/Program: ___________________________________________________________

Courses selected to satisfy the supplemental requirement must be approved, in order, by your academic advisor, Division Head, and the Office of Student Services. Students are strongly encouraged to obtain these approvals prior to enrollment in supplemental coursework.

1. List a minimum of three courses you propose as meeting the supplemental course requirement. Include course department, number, title, instructor of record (if available), and a brief course description. Cognate courses may be selected from any degree-granting department(s) on campus (outside of Education). NOTE: your advisor/division may require up to five courses to satisfy the supplemental requirement.

a.

b.

c.

2. List and describe two alternate course you will use in the event of scheduling problems.

a.

b.

3. Please describe how the three courses selected in (1) represent a coherent program of study.

_____________________________________ Student's signature

_____________________________________ Advisor'ssignature

_____________________________________ Director, Office of Student Services' signature

_____________________________________ Division Head's signature

Return to Table of Contents pbe: 30Sep97

updated