OFF-CAMPUS PETITION FORM
FINE ARTS & LECTURESHIP SERIES
To: FALS Committee
Lander University
Date:_____________________
From: Student Name ________________________________ LU# ______________________
Phone ________________________________email __________________________________
Student signature: ______________________ Official signature______________________
I request I be given credit for the following as an approved FALS event:
____________________________________________________________________________
____________________________________________________________________________
Date of your visit: ______________________________
Please submit this completed form along with a ticket stub, program or other proof of
attendance and a one-page typewritten description indicating how the
event/exhibit/performance increased your understanding of cultural values.
This form and ALL accompanying materials should be submitted to the drop box located in the
University Post Office (drop box is to the left as you walk in the door.) Petitions will be
reviewed by the FALS committee on a monthly basis around the 15
th
of each month. The
registrar’s office will notify you if the petition has not been approved.
FALS COMMITTEE USE ONLY: DATE Received: _______________________
APPROVED DENIED
Comments: __________________________________________________________
____________________________________________________________________
FINAL APPROVAL Date:_____________________
SIGNATURE: FALS Committee Chair: ___________________________________
