Surname
given names I.D. number
GRADUATE PROGRAM SERVICES
department/school program
GRADUATE STUDENT PETITION FOR ACADEMIC CONSIDERATION
FOR SEMESTER: Fall Winter Summer
year
I hereby request academic consideration as described below:
Student’s Signature: Date:
ACTION REQUESTED: (specify affected course(s))
Late Add (attach signed Add/Drop form):
Late Drop (attach signed Add/Drop form):
Extend INC Privilege:
Other (describe):
GROUNDS FOR CONSIDERATION:
Medical Psychological Compassionate
Provide Explanation Below:
Additional explanation attached Yes No
List of Documents submitted in support of this Petition (may include supporting letter from program Graduate Coordinator):
1. 4.
2. 5.
3. 6.
OFFICE USE ONLY: Received:
Written Documentation Attached? Yes No
Admissions & Progress Committee meeting:
Decision: Granted Denied Tabled
Comments:
petition.form: x/01
INSTRUCTIONS FOR THE USE OF THIS FORM
The student must complete all sections and submit the form, along with any supporting
documentation, to Graduate Program Services. The request will be presented to the Admissions
& Progress Committee of the Board of Graduate Studies for review and subsequent action.
(This is comparable to an Academic Review petition at the undergraduate level.)
ACTION REQUESTED:
Late Adds: for use after the end of classes for the term in question.
Late Drops: for use after the 40
th
class day for the term in question.
Extend INC privilege: for use where student is unable to complete an incomplete course in the
very next semester for whatever reason.
Other: indicate exactly what consideration you are requesting.
GROUNDS FOR CONSIDERATION:
This is an opportunity for you to explain to the committee why it should consider this petition.
Whatever the reasons, an explanation from yourself is essential. If the reasons are medical,
psychological, or compassionate, supporting documentation (from a medical or other
professional practitioner as appropriate) should be submitted.
List the supporting documents in the space provided. Appropriate supporting documentation
should be included.
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