Dean of Students Request Form
Dean of Students Office
NAVAL
POSTGRADUATE
SCHOOL
pg. 1 of 1
Middle Initial
First Name
Student Information
Last Name (student)
Change Request Details
Original PRD
Original Graduation Date
Desired Detach Date
Circumstances/Justification
Has this request been communicated to and approved by Detailer?
Desired Graduation Date
Designator (USN only) Curriculum #
Rank
Service
Date
Yes
No
Email this completed form to your Program Officer (via service representative if not USN). You will be notified by your
Program Officer of request status.
To: Dean of Students
Via:
(1)
, Program Officer
, Director of Programs
, Deputy Dean of Students
Ref: (a) Student Handbook
(2)
(3)
(4)
Approved / Disapproved
Request Due To (select one):
Detailer (name and contact info):
Detailer’s Approval Documentation:
If your Detailer provided approval via email or other written format, please include documentation and Detailer’s
information with this request submission (forward original email or attach file documentation).
,
Select Option:
Select Option:
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