Petition for Exception
Name __________________________________________________________________ Date: _
__________________________
Student ID: _______________________ Phone: _______________________ Expected Grad Term: ______________________
E-mail Address _________________________________________________ Have you applied to graduate
? ___________________
Major/Area of Conce
ntration/Emphasis &/or Minor _________________________________________________________________
Instructions: This form is used to request an exception to a University policy or deadline. A separate form is available for course
substitution requests. PLEASE NOTE: If the approved exception is for a major that requires an emphasis, the update will not be made until
the required emphasis has been declared.
1. Please write legibly and attach any documentation necessary to support your request. Attach additional sheets as needed.
2. Fill out the "Request" and "Reason" sections and sign/date the form
3. Please sign and return to the Registrar’s Office in the Enrollment Center, Sage Hall. You may also turn in this form via mail or e-mail to
registrar@csuci.edu. Form will be routed for review on your behalf. Results will be sent to student e-mail.
Student’s Request (attach additional sheets if needed):
Student’s Reason (attach additional sheets if need):
Student’s Signature _________________________________________________________ Date ___________________________
Instructor / Advisor / Staff Comments & Recommendations:
Signature ________________________________________________________________ Date ___________________________
INTERNAL USE ONLY
Program Chair / Dean Comments & Recommendations:
Approved __________________________________________________________________________________________
Denied Signature ___________________________________________________ Date ___________________________
University Registrar’s Comments & Recommendation:
Approved __________________________________________________________________________________________
Denied Signature ___________________________________________________ Date ___________________________
Office Use Only- Registrar’s Office
Processed by: ___________ PS Update: __________ Student Notified: ___________
(Staff Initials) (Date) (Date) Revise 06/d 07/2019
Enrollment Management
Registrar’s Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
www.csuci.edu
