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MALONE UNIVERSITY
Academic Petition
STUDENT NAME: _________________________________________________________ DATE: ___________________
First Middle Last
MAJOR: ____________________________________ CLASS (check one): FR SO JR SR Other
INSTRUCTIONS (in sequential order):
1. Complete the top portion of this petition and submit it to: a) the Academic Department Chair responsible for the course, major or
policy under review, OR b) the Director of General Education if the request involves a course, component or policy pertaining to the
Malone General Education Program. Attach any pertinent information or documentation that may support your request. Based upon
the information submitted and other relevant factors, the appropriate authority will make a recommendation to affirm or deny the
petition. Sign, date and forward the petition to the Office of the Registrar by email at registrar@malone.edu.
2. After assuring that the appropriate authority has completed the initial review of the request, the Registrar will review and comment
based on institutional policy. Upon review, the Registrar will sign and forward the petition to the Associate Provost (for university-level
action). No action is considered official until approved and signed by the Associate Provost. Should steps in this process be omitted or
incorrectly processed, the Registrar will re-route the petition back to the appropriate authority for review and action.
3. The completed petition will be returned to the Office of the Registrar as a permanent record of the final action with a copy of the
document being returned to the student.
I REQUEST PERMISSION TO (state specifically what you would like done):
RATIONALE (state in a clear and concise way why the above request should be granted and what supports your request):
Student Signature: _______________________________________________________ Date: _________________________
DEPARTMENT CHAIR/DIRECTOR OF GENERAL EDUCATION RECOMMENDATION (appropriate authority):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Signature: ______________________________________________________________ Date: _________________________
REGISTRAR’S COMMENTS:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Signature: ______________________________________________________________ Date: ________________________
ACTION OF THE ASSOCIATE PROVOST (appropriate authority):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Signature: ______________________________________________________________ Date: _________________________
