Name: _____________________________ SSN/Student No. ____________
Semester __________ Year _________
List Courses That Conflict:
________
_______ _____
_________ _____________
Department
Course No.
Section
Days
Time
________
_______ _____
_________ _____________
Department
Course No.
Section
Days
Time
________
_______ _____
_________ _____________
Department
Course No.
Section
Days
Time
Describe How Conflict is to be Resolved
________________________________________________________
________________________________________________________
________________________________________________________
____________________________________
_______________
Signature of Instructor(s)
involved in the resolution
Date
____________________________________
_______________
Signature of Department
Chair for Instr. involved in resolution
Date
____________________________________
_______________
Signature of Dean of College
for Instr. involved in resolution
Date
Print form and bring to Registrar's Office (200 Founders Hall) when all signatures are obtained.