Student Services
40 Avon Street
Keene, NH 03431-3516
Phone: 603-283-2490
Fax: 603-357-7563
Studentservices.ane@antioch.edu
PETITION for EXCEPTION to ACADEMIC POLICY
1. Fill in all sections below.
2. Obtain Program Director signature. (Student Services will obtain Registrar and Academic Officer’s signatures.)
3. Sign and date the form.
4. Submit completed form to Student Services (Keep a copy for your records).
Name: __________________________________________________________________ Student ID: _______________________
Antioch Email Address: ________________________________________ Phone Number: _______________________________
Program: __________________________________________ Current Enrollment Status:
Part-Time Full-Time
Term/Year of requested change: Spring 20___ Summer 20___ Fall 20___
What specific exception would you like to request? (e.g. late add, drop, or withdrawal; exception to grading policy, etc.):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Course Number & Section: _____________ Title: _______________________________________ Faculty: ___________________
Why is this exception being requested? __________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Student Signature: ______________________________________________________________________ Date: ________________
Program Director Signature: _________________________ Printed Name: ________________________ Date: ________________
Registrar’s Office Signature: ______________________________________________________________ Date: ________________
Academic Officer Signature: _____________________________________________________________ Date: _______________
• The student is responsible for checking the Academic Catalogue for policy details, fees, deadlines, etc.
• Confirmation of approval or denial will be sent via Antioch email.
• Policy exceptions are made in the context of an individual student’s circumstances and may not apply to all students.
Revised 2.25.2019 Please allow 3 weeks for approval routing and processing.
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