Saint Louis University Graduate Education
Petition for an Extension of the Time Period to Complete Degree Requirements
INSTRUCTIONS TO STUDENT: 1) Complete the first portion of the form; enter your name, student ID number, telephone no., mailing address, and
e-mail address in the space designated; then date and sign the form. 2) Attach to this form a letter detailing your request and providing your rationale
for approval. 3) Also attach, or include within the letter, an envisioned detailed time-table (schedule) for the completion of remaining degree
requirements. Extensions approved are ordinarily granted for a maximum of one calendar year. 4) Your petition with attachment(s) must be routed
to your academic advisor, your department chairperson (or program director), the Dean/Director/Designee of your College/School/Center, and finally
to the Candidacy Advisor, DuBourg Hall, room 420B, for review and consideration by the Associate Provost – Graduate Education. You, the
student, are responsible for this routing.
I,_______________________________________, petition to extend my time-period to complete degree requirements.
(Student: Print/Type your name)
Student’s Signature:___________________________________________________________ Date:_________________
Banner ID:_______________________ Day Phone #:____________________ Email:_____________________________
Local Address:______________________________________________________________________________________
(Street, Apt #) (City) (State) (Zip Code)
Degree Sought:_____________________________ Current Major:_____________________________
I recommend approval denial Print/Type Full Name:_______________________________________
of this petition.
Signed:__________________________________ Date:_____________
(Advisor)
I recommend approval denial Print/Type Full Name:________________________________________
of this petition.
Signed:___________________________________ Date:____________
(Chairperson/Director)
I recommend approval denial Print/Type Full Name:________________________________________
of this petition.
Signed:___________________________________ Date:____________
(Dean/Director/Designee of School/College Center)
Remarks and/or Special Conditions of the Major Field: ________________________________________
Petition is approved denied Signed:_____________________________ Date:______________
(Associate Provost – Graduate Education)
Remarks/Conditions of Extension:
________________________________________________________________________________________________
Copies sent to Student Advisor Chairperson/Director Dean/Director/Designee on _____________
(Date)
