PETITION FOR POLICY EXCEPTION
THIS FORM IS TO BE USED TO REQUEST AN EXCEPTION TO AN ORU CATALOG POLICY
1. Include all relevant course information. (COURSE NUMBER, TITLE, TERM, GRADE AND INSTRUCTOR)
2. Obtain appropriate signatures. *(See back of form for routine requests)
3. Return all copies to the Registrar’s Office. (Please allow a minimum of 2 weeks for processing.)
Name: _____________________________________________________ Z#: __________________________
Last First MI
Email: _______________________@oru.edu Phone: ____________________ Birthdate: _________________
Local Address: ________________________________________________________ Date:________________
Major: ____________________________________ FR ___ SO___ JR ___ SR ___ GRAD ____
Please check: I receive veteran’s benefits. ___Yes ___ No
I am an international student. ___Yes ___ No I am a student athlete. ___Yes ___ No
STATEMENT FOR PETITION:
Student Signature: ___________________________________________________________________________
Approved
Not Approved
________________________________________________
Instructor
_________________
Date
Approved
Not Approved
________________________________________________
Department Chair
_________________
Date
Approved
Not Approved
_______________________________________________
College Dean
_________________
Date
Approved
Not Approved
_______________________________________________
Vice President for Academic Affairs
_________________
Date
Approved
Not Approved
_______________________________________________
Student Accounts*
_________________
Date
Registrar--White Major Department—Canary Student.—Pink Revised 09/10/12
*Required for an Audit-to-Letter grade change that raises enrollment
above 18.5 credit hours or all part-time enrollment (11.5 credit hours
or less) and all schedule adjustments made after the drop/add period.
