Fillable Acadvar Academic Variance Petition (Loma Linda University)

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Acadvar Academic Variance Petition (Loma Linda University)

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University Records
Petition for Academic Variance
Select One
Go
Personal Information
Petition for Academic Variance
Verification - For Office Use Only
Faculty's Action:
Support
Do not support
Department's Action:
Support
Dean's Action:
Support
Do not support
If you have any questions please email registrar@llu.edu or call 909-558-4508
Instructions:
1. Please complete form on the web, print, and sign with a ball point pen.
2. State your request completely and clearly.
3. Provide adequate information for a decision.
4. Include reason for request.
5. Obtain approval from your department office.
6. Leave petition at the Office of the Dean/Associate Dean of your school of enrollment for processing with University Records.
I hereby request the following variance from academic policy:
NOTE: Please attach a course outline, including required textbooks, and other supporting documents.
Units
Number
Prefix
Course Title
Term
Year
Units
College/University
(Note: if the Request Type selected is "transfer," there is no need to provide an LLU Course in the table below.)
Request Type
Comments
(Note: if the Request Type selected is "transfer," there is no need to provide an LLU Course in the table below.)
Request Type
Select One
Select One
Student ID#
Student Information
Name: Last
First
Select One
Email
Middle
LLU School
Program of Study
Select One
Academic Level
Degree
Expected Graduation Date: (MM/DD/YYYY)
/
Phone Number
/
Date:
Date:
Date:
Student Signature:
Date:
Faculty's Signature:
Department's Signature:
Dean's Signature:
Faculty's Comment:
Department's Comment:
Dean's Comment:
Units
Number
Prefix
Course Title
LLU Course
With
LLU Course
With
Prefix
Number
College/University
Number
Prefix
Course Title
Course Title
Comments
Term
Year
Units
Units
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Acadvar Academic Variance Petition (Loma Linda University)

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Completed 23 July 2020

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