Revised Feb 2010
Name: ___________________________________ID number: _________________
E-Mail: _________________________________Phone:________________________
Address:______________________________________________________________
City: _________________State: ________ Zip Code:_______________________
Minor, Concentration,
or 2
nd
Major
(circle one)
1. Complete this form (incomplete or unprofessional submissions will not be accepted).
2. If applicable, attach supporting documents, including a professional letter of explanation.
3. Print a current MSUB web transcript and attach to the form.
4. Obtain College of Education instructor, faculty advisor and department chair signatures.
5. Submit to the ETP Office, Room 209, College of Education.
I petition the College of Education Appeals Committee to be allowed to deviate from the
Teacher Education Program as follows (attach a professional letter of explanation if more space is needed):
Student Signature ________________________________ Date ___________________
Instructor’s Recommendation: □ I support the petition □ I do not support the petition
(if applicable)
Instructor’s Signature __________________________________ Date ___________________
COLLEGE OF EDUCATION
PETITION FORM
Rationale (please refer to College of Education policy and/or extenuating circumstances):
