Student Name:_________________________  Social Security Number______________

Address:___________________________________________________________________

Telephone Numbers: Home___________ Work____________ Cell_____________

E-mail address:_____________________________________________________________ 

Expected year of graduation:___________

Semester:          Spring__________  Summer____________  Fall______________

Enter your associate or certificate program code:_____________________

             Option:____________________________________________________

Have you submitted an Academic Standards Petition: Yes________ No________

If yes, what was the request? ___________________________________________

Was the petition approved?             Yes__________  No_______________

Do you have transfer credits that have not been evaluated?  Yes______ No_______

Are you planning to attend a four-year school?  Yes___________  No__________

If yes, name of college:_____________________________________________________

Intended major:____________________________________________________________

_________ Please hold my Unofficial Curriculum Review in Counseling, Advising, and Retention Services.  I will pick it up at the reception counter within 2 weeks.

_________ Please mail the Unofficial Curriculum Review to me at the above address.

Counseling, Advising, and Retention Services will make every effort to process your request within 72 hours.  During peak registration times (July and August; December and January), Unofficial Curriculum Reviews will not be accepted.

I understand that this review is UNOFFICIAL and that I must submit a graduation application to the Records and Registration Office by the published submission date to receive an official degree audit.

___________________________________________  _______________________
Student Signature (Required)                                      Date