UNIVERSITY OF WASHINGTON, Department of Health Services 
EXTENDED MPH DEGREE PROGRAM 
Email:  uwedp2@u.washington.edu 
(206) 685-7580 

PETITION TO APPROVE ELECTIVE CREDITS NOT TAKEN THROUGH ExDP

--If doing an independent study through ExDP, please use the "Independent Study (600-level) Learning Contract" instead.--

Form Instructions: 
Copy the entirety of this template into an email and fill out this form.  Send this email to: 

uwedp2@u.washington.edu

To ensure applicability to Program requirements, STUDENTS MUST SEEK APPROVAL OF ELECTIVE COURSE WORK PRIOR TO REGISTRATION.

-Course work must be taken at an accredited university or college.
-Must be 400-600 level graduate courses.
-and may not have counted towards a previous degree. 

Students may receive approval for up to three credits for a public health elective taken outside the program.

COMPLETE THE BELOW INFORMATION AND SEND VIA EMAIL TO ExDP OFFICE WITH A COPY OF THE COURSE SYLLABUS/OUTLINE (see email address above).  

After this request is reviewed and approved, notice of approval will be sent to the student via email. Upon receipt of documentation showing successful completion of the course (i.e., grade report or transcript), credits will be applied to the program record. 


A. Student Information:
Student Name:________________________________
Phone #(s):__________________________
E-mail:_____________________________



B. Elective Course Details:
Department abbreviation for course:______________________
Course #:__________________
Course Title:_____________________________________________________________
SLN # (if at UW):_____________________
Number of Credits:_______________
Quarter and Year:____________________
Taught in a Quarter or Semester system:______________
Name of University/College:________________________________________________________
Grade received (if already taken):_______

Please submit a brief description of course and/or course objectives if taken outside the University of
Washington: