Fillable SCHOOL OF GRADUATE STUDIES PETITIONS FOR SPECIAL CONSIDERATION (McMaster University)

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SCHOOL OF GRADUATE STUDIES PETITIONS FOR SPECIAL CONSIDERATION (McMaster University)

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SCHOOL OF GRADUATE STUDIES
PETITIONS FOR SPECIAL CONSIDERATION TO THE
COMMITTEE ON GRADUATE ADMISSIONS AND STUDY
Updated October 2018
Notes:
1)
Once the student has completed part A of this form, it should be submitted to the department or program office.
Departments are responsible for completion of Parts B and C and submission of the form to the School of Graduate Studies.
2)
Please ensure Parts A, B, and C of this form are fully completed, giving sufficient information to provide a sound basis for
making decisions.
3)
All petitions should be completed in accordance with the regulations outlined in the Calendar of the School of Graduate
Studies.
4)
Please allow one month from the date that the form is submitted to the School of Graduate Studies for a response to your
petition.
FIRST
NAME
FAMILY
NAME
STUDENT
NUMBER
FULL-TIME
PROGRAMME
DEGREE
PART-TIME
NATURE OF PETITION:
LEAVE OF ABSENCE
1
OTHER
2
Specify:
1) Use this form for leaves of absence that do NOT include pregnancy or parental leave. If you are
requesting a Pregnancy or Parenting Leave please use the Parenting Leave form:
https://gs.mcmaster.ca/sites/default/files/resources/parenting_leave_june_2018_june_2018.pdf
2) e.g. Petition for change in supervisor, extension on annual supervisory meeting, deferred course
examination waiver of adverse ruling or decision about academic performance for compelling medical*
personal or family reasons; adjustment in the timing of re-entry into program or to defend a thesis,
retroactive drop/add.
*please note that any requests for long
-term accommodation of more than one term are to be directed to the Student Accessibility Services. More
information is available in the Academic Accommodation of Students with Disabilities Policy:
https://www.mcmaster.ca/policy/Students-
AcademicStudies/AcademicAccommodation-StudentsWithDisabilities.pdf
This form is not to b
e used for extension requests (other than to the annual supervisory committee meeting) or
for in
-program course adjustments. For those changes please refer to the Extension Request Form or the In-
Program Course Adjustment Form.
PART A: STATEMENT BY STUDENT
THIS CHANGE IS TO BE EFFECTIVE AS OF THE FOLLOWING DATE:
(DATE FORMAT YYYY-MM-DD)
FOR A LEAVE OF ABSENCE, SPECIFY END DATE:
D
ATE
S
IGNED
S
IGNATURE
PLEASE PROVIDE YOUR E-MAIL ADDRESS
PLEASE SUBMIT THE FORM TO YOUR DEPARTMENT AFTER COMPLETING PART A:
B. STATEMENT BY SUPERVISOR: (or if there is no supervisor, by the faculty member most familiar
with the student’s work)
DATE
PRINTED
NAME of Faculty Member
SIGNATURE
C. STATEMENT BY CHAIR / GRADUATE ADVISOR / PROGRAMME AREA CO-ORDINATOR
NOTE: IF THIS REQUEST IS FOR A LEAVE OF ABSENCE, THE FOLLOWING INFORMATION MUST BE COMPLETED BY THE
DEPARTMENT:
NUMBER OF HOURS COMPLETED BY THE STUDENT TERM 1 TERM 2 TERM 3
STOP ALL STUDENT’S PAY EFFECTIVE MONTH DAY YEAR
DATE
PRINTED
NAME
SIGNATURE
D. REVIEW AND DECISION OF THE SCHOOL OF GRADUATE STUDIES
DATE
PRINTED
NAME
SIGNATURE
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SCHOOL OF GRADUATE STUDIES PETITIONS FOR SPECIAL CONSIDERATION (McMaster University)

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Completed 9 December 2020

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