ADMINISTRATIVE PROCEDURES PETITION FOR
M
NAME (LAST, FIRST, M.I.)
Student ID#
E-MAIL ADDRESS
CITY STATE ZIP
MAJOR DATE PETITION INITIATED
LIMIT EACH PETITION FORM TO A SINGLE REQUEST - TYPE OR PRINT, AND USE BLACK INK.
BE
SPECIFIC AND CLEAR IN YOUR REQUEST, I.E. SPECIFY COURSE(S) BY NAME AND NUMBER
IF APPROPRIATE, ATTACH ADDITIONAL DOCUMENTATION TO THE PETITION.
ACTION REQUESTED (Be Specific):
WHY COMMITTEE SHOULD APPROVE YOUR REQUEST (Be Specific):
OFFICE OF THE REGISTRAR
UNIVERSITY OF NORTH DAKOTA
LOCAL ADDRESS STREET
LOCAL PHONE NO. EXPECTED GRADUATION DATE
INSTRUCTIONS
IT IS THE RESPONSIBILITY OF THE STUDENT TO COMPLETE THE PETITION, OBTAIN THE NECESSARY SIGNATURES AND SUBMIT THE FORM TO THE
OFFICE OF THE REGISTRAR, ROOM 201, TWAMLEY HALL.
STUDENT SIGNATURE:___________________________________________________________________________________________________
JUSTIFICATION OF RECOMMENDATION SIGNATURE DATE
APPROVE
DIS-
APPROVE
NONE
ACADEMIC
ADVISER
INSTRUCTOR
OF COURSE
DEPT. CHAIR
OF COURSE
DEAN OF
COURSE
STUDENT'S
ACADEMIC
DEAN
Extension of time to remove an incomplete: Instructor, Dept. Chair, Dean of Course
Changes or Drops after deadline:
Total Withdrawal after deadline: Adviser, Chair of Student's Major, Student's Dean
Questions regarding all other types: Contact the Office of the Registrar.
COMMITTEE'S ACTION: APPROVED DISAPPROVED
OTHER_______________________________________
DATE________________________________________
Adviser, Instructor, Dept. Chair, Dean of Course, Student's Dean
RECOMMENDATION
ACTION: SIGNATURES REQUIRED:
Updated 01-08-07
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