Request for Late Registration for Internship
Please type all information requested. Print the form, obtain the appropriate signatures
and submit to the Registrar’s Office for processing. Note: Any unauthorized changes,
altered dates or forged signatures will result in disciplinary action.
Sections 1 and 2 must be completed BEFORE obtaining the Dean’s signature.
Section 1
Student Name: ____________________________ Student ID#: ___________________
Local Address: _____________________________ Local Phone: ___________________
City: _____________________________________ State: ________ Zip: _______________
Current Semester: _________ CRN: ________ Course SUBJ/NUMBER: ______________
Instructor: ____________________________________________________________________
Reason for this request: (Please note: Being unaware of the deadline is not a valid
reason for an exception.)
Student Signature: _______________________________________ Date: _______________
Section 2 Instructor’s Recommendation
( ) I support ( ) I DO NOT support the petition.
Faculty Signature: ________________________________________ Date: ______________
Section 3 - Dean’s Signature
( ) I support ( ) I DO NOT support the petition.
Dean’s Signature: ________________________________________ Date: ___________
*Dean of the Division in which the course is taught