School of Health Professions
DEPARTMENT OF PHYSICAL THERAPY
COURSE WAIVER REQUEST
Student Name:
PID (if you know it):
Entry Year to UTMB PT if accepted:
Prerequisite Course that you wish to waiver:
Course name and number of requested substitution:
University where course was taken:
Term when course was taken:
DECISION BY COMMITTEE:
Course Description and syllabus can be copied below or attached electronically and sent to jbelliso@utmb.edu or faxed with this form to 409-747-1613.