"Amendment to an Approved Interdisciplinary Studies Major, Individually Designed Major, and Individually Designed Minor - University of Wisconsin"

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This is a fill-in form.
Tab throughout to enter your
information. When finished,
University of Wisconsin-Superior
print and submit to your advisor.
68-1000-3 (Rev. 09/15)
Name: ______________________________________________________
Student ID #: _______________________________
Address: ____________________________________________________
Home Phone: (_______)_______________________
City, State, Zip: _______________________________________________
Work Phone: (_______)_______________________
Amendment to an Approved Interdisciplinary Studies
Major, Individually Designed Major, and Individually Designed Minor
Note to student: A copy of the previously approved major must be attached.
1) Discipline to be amended: _________________________________________________
Action to be taken: ____________________________________________________________________
Reason:
Faculty approval: ____________________________________________________
______________________________
Signature
Date
2) Discipline to be amended: _________________________________________________
Action to be taken: ____________________________________________________________________
Reason:
Faculty approval: ____________________________________________________
______________________________
Signature
Date
Print this form and submit to your advisor.
Student ________________________________________________________________
Date____________________________
Advisor ________________________________________________________________
Date____________________________
Exec. Dir., Altern. Del. & Outreach ___________________________________________
Date_____________________________
University Credits Committee:
Approved
Denied
Registrar ________________________________________________________________
Date____________________________
This is a fill-in form.
Tab throughout to enter your
information. When finished,
University of Wisconsin-Superior
print and submit to your advisor.
68-1000-3 (Rev. 09/15)
Name: ______________________________________________________
Student ID #: _______________________________
Address: ____________________________________________________
Home Phone: (_______)_______________________
City, State, Zip: _______________________________________________
Work Phone: (_______)_______________________
Amendment to an Approved Interdisciplinary Studies
Major, Individually Designed Major, and Individually Designed Minor
Note to student: A copy of the previously approved major must be attached.
1) Discipline to be amended: _________________________________________________
Action to be taken: ____________________________________________________________________
Reason:
Faculty approval: ____________________________________________________
______________________________
Signature
Date
2) Discipline to be amended: _________________________________________________
Action to be taken: ____________________________________________________________________
Reason:
Faculty approval: ____________________________________________________
______________________________
Signature
Date
Print this form and submit to your advisor.
Student ________________________________________________________________
Date____________________________
Advisor ________________________________________________________________
Date____________________________
Exec. Dir., Altern. Del. & Outreach ___________________________________________
Date_____________________________
University Credits Committee:
Approved
Denied
Registrar ________________________________________________________________
Date____________________________