Part 1.  To be completed by the student

Name: ___________________________________________  Year of graduation: ______

Institution where the course is offered: ________________________

Course field and number: ______________________  Semester and year: ____________

Course title: ____________________________________________________

Instructor's name: _______________________________________________

Please list the graded writing assignments for this course, as shown in the course syllabus.  To satisfy the writing requirement, a course must assign at least 5,000 words (or at least eighteen pages) of formal graded writing, excluding exams, short response papers, e-mail or online discussion contributions, and in-class writing. 

Description of assignment:_____________________________  Minimum length:        

Part 2.  Signatures

This course satisfies the HMC writing requirement as described in bold above:

            Instructor:  __________________________________________________

            HSA Advisor:  _______________________________________________

To the advisor: Please be sure the advising database reflects your approval of this course and give this form to the HSA Department's advising coordinator.