COLUMBIA STATE COMMUNITY COLLEGE

DEVELOPMENTAL STUDIES PROGRAM

COURSE RECOMMENDATION FORM

 

 

 

 

Student’s Name:  ________________________________     SSN:  ________________________

 

Semester:  _______________________                                 Date:  ________________________

 

Current Course:  _______________                            Desired Course:  _____________________

                            _______________                                                      _____________________ 

 

 

Reason for Change:  ____________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

 

 

 

My signature on this form acknowledges my acceptance of the above placement regardless of the placement indicated for me by my placement data.  Furthermore, I acknowledge that I will be required to take all subsequent courses remaining in the DSP content area affected by the above placement.

 

Student’s Signature:  _____________________________  Date:  ____________________

 

 

 

 

DSP Instructor’s Signature:  ___________________________           Date:  __________________

 

 

DSP Director’s Signature:  ____________________________           Date:  __________________

 

 

 

 

ORIGINAL – DSP OFFICE

CANARY – STUDENT’S COPY

 

 

REV. 02/05