Name:
Last
Middle
First
Contact Phone Number:
myUH ID:
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“State law requires that you be informed of the following: (1) with few exceptions, you are entitled on request to be informed
about theinformation the university collectsaboutyoubyuseofthisform;(2)undersections552.021and552.023oftheGovernment
Code,youareentitledtoreceiveandreviewtheinformation;and(3)undersection559.004oftheGovernmentCode,youareentitledto
havetheuniversitycorrectinformationaboutyouthatisincorrect.”
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Program
NOTE: Unless otherwise stated and approved, all petitions are effective at the start of the next academic term. All administrative
actions become effective the day they are processed, unless otherwise stipulated and approved via petition. All petitions should be
submitted to the advising office in the department of their degree objective to begin the approval process.
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ALIAS:
PURPOSE OF PETITION
1.
Update program status/action
(term activate, discontinue, etc)
2.
Admissions status change (ex: conditional
to unconditional)
3.
Add new concurrent degree or certificate
4. Change current degree objective
(program/plan)
5.
Degree requirement exception or
approved course substitution
6.
Leaveof Absence (include specific term)
(Attach supporting documentation)
8.
Request to apply to graduate after
the late filing period deadline
Institution Name
City/State/Zip
Courses
Approved
for Transfer:
Hours Previously Transferred
Transfer Credits on this request
12. Other (explain below)
EXPLANATION
OF REQUEST
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DATE
Administrative Request
ACADEMICOFFICE USE ONLY
Signature
Print Name
Date
APPROVED DISAPPROVED Signature
Vice Provost/Dean of the Graduate School
COMMENTS
3ODQ Code
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@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@______@@@@
@___@___@@@___@
APPROVED
DISAPPROVED
Graduate Studies/Program Director
Graduate Advisor/Commitee Chair
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Year
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Signature
Print Name
Date
@___@___@@@___@
Signature
Print Name
Date
@___@___@@@___@
APPROVED
DISAPPROVED
Department Chair if required
Print Name
Date
@___@___@@@___@
APPROVED
DISAPPROVED
Assoc/Asst Dean
for Graduate Studies.
Signature
Print Name
Date
@___@___@@@___@
APPROVED
DISAPPROVED
9. Transfer Credit
[One Institution per petition]
Λh,͘h^ƚƵĚĞŶƚƐĂƌĞƌĞƋƵŝƌĞĚƚŽŵĂŝŶƚĂŝŶĂǀĂůŝĚĚĞƐƚŝŶĂƚŝŽŶĞŵĂŝůĂĚĚƌĞƐƐŝŶƚŚĞŝƌŵLJh,ĂĐĐŽƵŶƚ
objective
(career/program/plan)
7.Reinstatement to discontinued
career (provide explanation)
Catalog #: Sem/Qtr Taken:
Catalog #: Sem/Qtr Taken:
Catalog #: Sem/Qtr Taken:
Transfer
Credit
Awarded:
General
Elective
Credit
UH Graduate
Course
Equivalencies:
Catalog #:
Catalog #:
Catalog #:
(attach additional
documentation as
needed)
10. Change Admit Term
11.
Early Submission of Thesis/
Dissertation
UHGS 0219
