P
ETITION TO GRADUATE COUNCIL
Date: _______________
Full Name: ___________________________________________________________ Student ID#:___________________________
E-Mail: __________________________________________________Telephone: _________________________________________
Address (local): ___________________________________________ Graduate Program: ___________________________________
Briefly state your request:
Rationale for Petition:
STUDENT _______________________________________________________________ DATE__________________________________________________________
ADVISER
DATE
DEAN/CHAIR DATE_________
Adviser Opinion: Agree Disagree Departmental Action: Approve Disapprove
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ACTION:
_______________________________________________________________________
DEAN OF GRADUATE STUDIES DATE