Academic Course Plan Instructions
The Academic Course Plan is a required form for any College Scholar with junior status as of fall semester 2015.
The Cooke Foundation uses the form to track each scholar’s course work and anticipated graduation date.
This form must be completed and signed by you and your academic advisor. If your institution has a similar form
that provides the information required by the Cooke Foundation, that form may be submitted instead of this form.
This form must summarize ALL semesters you are enrolled in, including the previous semesters and the upcoming
semesters.
► INSTRUCTIONS TO SCHOLAR
Please list the courses you must take for your bachelor’s degree. In the Course Name & Description column:
1) List required course titles and other details as available
2) List general requirements in broad terms, such as “required science course”
3) List elective courses by name when known or when unknown simply list as “elective” and number of credits
4) Total the number of credits for each semester/quarter
If your school is on the quarter system or if you need more space, you may attach additional sheets. Please ask your
advisor to review, approve, and sign this academic course plan. Submit the form via mail, email, or fax by:
Deadline: November 13, 2015 – College Scholars with junior status as of fall semester 2015
Please note that the Cooke Foundation provides funding for each scholar to complete the degree requirements for a
single major. If you include additional majors or a minor in your academic course plan, the course plan will not be
approved if doing so would require an extension of your graduation date beyond the time needed to complete the
degree requirements for a single major. However, the Cooke Foundation can approve an additional major or a minor
if a scholar completes those requirements within the original time frame without extending the scholarship and
without overloading on coursework.
Please return the form via email, fax or postal mail to:
College Scholarship Program
Jack Kent Cooke Foundation
44325 Woodridge Parkway
Lansdowne, VA 20176
(571) 209-1264 (fax)
collegescholars@jkcf.org
► INSTRUCTIONS TO ACADEMIC ADVISOR
Thank you for taking the time to advise this Jack Kent Cooke Scholar. Please work with the scholar to determine the
courses needed to complete his/her bachelor’s degree. Once you review the academic course plan indicate your
approval by signing the form.
www.jkcf.org
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Academic Course Plan
Scholar Name
Last
College/University
Academic calendar
Start Date
First
MI
Major
Semesters
Quarters/Trimesters
Other
Graduation Date
mm/yyyy
mm/yyyy
NOTE: If you require more than four years (eight semesters or 12 quarters) to complete your degree, you must request a scholarship
extension. The completed Academic Course Plan will act as the initial request. Any further changes will require additional paperwork
that you may obtain from the Cooke Foundation. Extension requests are reviewed on a case-by-case basis.
Step A
Transfer credits accepted towards your degree (including AP and/or
IB credits earned)
+
Step B
Credits from this college/university needed to graduate
=
Step C
Total Credits needed to graduate
Step D
Total Credits listed in Academic Course Plan*
*Total credits listed in the Academic Course Plan may exceed the Step C total. If so, please provide a brief explanation.
Step E
Minimum number of credits required per semester to be considered
full-time by your school
Scholar: By signing below, I certify that the following academic course plan is a full list of courses I must successfully
complete to fulfill the requirements for a bachelor’s degree at my four-year institution.
Scholar Signature
Date
Advisor: By signing below, I certify that the following academic course plan is a full list of courses that the scholar
named above must successfully complete to fulfill the requirements for his or her degree at this institution.
Advisor’s Signature
Advisor’s Name & Position (please print)
Advisor’s Phone
www.jkcf.org
Date
Advisor’s Email
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Please begin with your first term. Complete a table for EACH semester/term from fall of freshman year to your final
semester senior year. Incomplete documents will be sent back to you.
Semester
Course Name & Description
(Specify semester here; e.g., fall 2013):
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
www.jkcf.org
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Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
Semester
Course Name & Description
Course #
Credits Required? Yes/No (major, general /core course, or elective)
Total Credits
If you are in a school on the quarter/trimester system or if you need more space, you may attach additional sheets.
www.jkcf.org
Page 4 of 4