Office of the Registrar
300 The Fenway, Boston, MA 02115
Tel 617.521.2111 Fax 617-521.3144
PETITION TO THE ADMINISTRATIVE BOARD
Student Name: ________________________________________ Student ID: __________________________
Cell Phone #: __________________________ Simmons Email: ___________________________________________________
Adviser: ________________________ Major(s): _______________________ Graduation month/year: ___________________
Please choose your reason for Petitioning the Administrative Board from the following options:
I am Petitioning the Administrative Board for a Registration Deadline Exception:
Add a course after 4
Formal Audit Grading Option after 4
Withdraw from a course after 8th week
Retroactive Withdrawal from a course (previous semester)
Other Registration Deadline Exception:_____________________________________________________________________
I am Petitioning the Administrative Board for a Course Exception:
Overload of Credits (more than 21)
More than 16 credits while on Probation
Transfer in more than 16 Summer Credits
Take a course at another institution while also taking courses at Simmons during the Fall or Spring Semester
Other Course Exception: ________________________________________________________________________________
I am Petitioning the Administrative Board for a Grading Exception:
Incomplete Grade (current semester)
Incomplete Grade Extension
Pass/Fail Grading Option after 4
Pass/Fail Grading Option Reversal after 4
Retroactive Incomplete (previous semester)
I am Petitioning the Administrative Board for an Academic Standing Exception:
Readmission to the University
Extend Leave of Absence (after four consecutive semesters)
Student Signature: _____________________________________________________ Date: ______________________
REQUIRED MATERIALS FOR ALL PETITIONS
1. This Petition to the Administrative Board form, with student signature (above).
2. Personal statement from the student outlining the reasons for requesting an exception to University policy. There is no
length requirement, however the statement must explain clearly and fully the student’s reasoning and request for an
exception. Personal statements can be emailed directly to email@example.com.
3. Statement of support/electronic signature from advisor sent to firstname.lastname@example.org.
4. Completed form that corresponds with the student’s request (e.g.: Completed Add/Drop form, Petition for Incomplete
Grade, Petition for Transfer Credit, etc.).
1. Letters of support from any outside parties the student may have worked with about the exception requested prior to
petitioning (e.g.: Student Life or Professors).
2. Medical Documentation from any facility or caregiver.
All materials should be submitted in person to the Office of the Registrar (Room C115) or directly to email@example.com.
After your petition has been reviewed by the Administrative Board, you will receive an email with the decision within one
business day of the meeting.
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