Department of Chemical and Petroleum Engineering
CHE Program PETE Program
Student's Name: _____________________________________________ Date: _____/____/_____
Student's W Number: _________________________________________
Local Address: _____________________________________________ Cum.GPA: __________
_____________________________________________ Class: Fr So Jr Sr Other
_____________________________________________ Grad. Date: ___/___/___
I request that the following courses, which [ were / will be ] (circle one) taken at:
______________________________________, be approved in lieu of the required courses listed below.
Ref. Course
Number
1
Course
Title
Credit
Hours
Semester
Taken
Grade
Received
--for --
Ref. Course
Number
1
Course
Title
Credit
Hours
Semester
Taken
Grade
Received
Justification:
Student: ______________________________________________ Date: ___/___/____
Advisor:______________________________________________ Date: ___/___/____
CHE/PETE Curriculum:_________________________________ Date: ___/___/____ Approve/Deny
Reviewed by Committee [ yes / no ]
Department Head: ______________________________________ Date: ___/___/____ Approve/Deny
Dean of Engineering:____________________________________ Date: ___/___/____ Approve/Deny
(if required)