University of Pennsylvania
Department of Chemistry
Waiver Application
1. Last name:
First name:
__________
2. Major:________________________________________________________________________________
3. Freshman 
Sophomore  Junior 
Senior 
4. School: College 

______________________________
Wharton 
CGS 
5. E-mail address:
____ 6. Local telephone number: _________________________
Other:
7. Chemistry Placement exam passed: Chem 101 
Date:______________________________________
Chem 102 
Date:_______________________________________
8. Other Placement Information:
 Advanced Placement
score:___________________________________
 International Baccalaureate
score:___________________________________
 A-Levels
grade:___________________________________
 Other Name:______________________________ score/grade:____________________
9. Name of former school:__________________________________________________________________
 Secondary
 Community College
 Other
____________________________________________________________________
City, State and Country: __________________________________________________________________
Dates of attendance: _____________________________________________________________________
Course name & numbers being considered:__________________________________________________
10. Requesting Penn Chemistry course numbers: _______________________________________________
If, you previously attended a college or high school that is not in the Chemistry Department transfer credit database, you
must also attach a catalogue description, syllabus, class notes, lab book with notes, and tests for the course(s) you have
taken.
Signature: _____________________________
Date: ________________________
Please return the completed form and necessary materials to the Undergraduate
Chemistry Office located in room 553.
Waiver letters do not carry Penn credit, but satisfy virtually all requirements, i.e. Chem /
Biochem Majors, SEAS lab requirement, Medical School applications, etc.
09/04

09/04