Fillable Academic Petition Revised 10 2012 ACADEMIC PETITION

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Academic Petition Revised 10 2012 ACADEMIC PETITION

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ACADEMIC PETITION
INSTRUCTIONS:
1. Consult with a faculty adviser regarding the request.
2. Submit the completed petition to the chair or dean.
Your chair or dean will make a recommendation regarding the request
and forward the petition to the director of Records and Advisement. After acting upon the
request, the director of Records and Advisement will forward the copies as specified below.
TO BE COMPLETED BY THE STUDENT
ID #: NAME:_________________________________________________ DATE:__________________
EMAIL: CONTACT PHONE:_______________________
MAJOR(S): CLASS STANDING:______________________
REQUEST AND REASONS:__________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
NAME(S) OF FACULTY MEMBER(S) CONSULTED:___________________________________________________________
COPIES: White—Records and Advisement; Yellow—Chair or Dean; Pink—Student
TO BE COMPLETED BY SPECIFIED FACULTY
ADVISER SIGNATURE:________________________________________________________ Date:__________________
COMMENTS:__________________________________________________________________________________________
_______________________________________________________________________________________________________
CHAIR OR DEAN RECOMMENDATION:
APPROVE
DENY
NO RECOMMENDATION
COMMENTS:__________________________________________________________________________________________
_______________________________________________________________________________________________________
____________________________________________ ____
____________________
CHAIR OR DEAN SIGNATURE DATE
TO BE COMPLETED BY RECORDS AND ADVISEMENT
DIRECTOR OF RECORDS AND ADVISEMENT:
APPROVE
DENY
NO RECOMMENDATION
COMMENTS:__________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
____________________________________________ ________________________
DIRECTOR OF RECORDS AND ADVISEMENT DATE
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Academic Petition Revised 10 2012 ACADEMIC PETITION

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Completed 14 February 2020

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