Revised February 2019
Student Services/Administrative Services
8295 E College Dr • Palmer AK 99645
Phone: (907) 745-9739 • Fax: (907) 745-9711
Request for Exception Form
• A student must officially drop/withdraw the course(s) before a petition for policy will be considered.
• Grade assignments and other academic issues can be included in this petition process.
• Petitions submitted more than one (1) year from date of registration will not be considered.
• Please allow a minimum of 6-8 weeks for processing your petition.
Type of Request: Deadline/Policy Course Refund Late Fee
(Please check all that apply) (Must drop/withdraw prior to request)
Name: ____________________________________
Last First MI
Mailing Address: ____________________________
City: _____________ State: _____ Zip: ________
UA Student ID: _____________________________
Phone: ___________________________________
Email: ____________________________________
Semester/Year Involved: _____________________
Course(s) involved: ex: MATH A105
__________________________________________________________________________________________
A separate, formal (typed or handwritten) statement explaining your request is required for petition to be considered. Any
document submitted will become part of your permanent academic record and will not be returned. Failure to provide relevant information will
result in a delay of the petition process.
By signing below: 1) Certify that the information contained in or included with this request is true and accurate; and 2) authorize anyone
contacted by Mat-Su College in connection with this request to discuss my application and to release relevant documentation in their
possession to Mat-Su College.
Student Signature: _________________________________________________________ Date: ____________
Academic/Financial Advisor Signature (recommended): ____________________________ Date: _____________
Advisor Comments: _________________________________________________________________________
The table below is intended to provide a description and minimum documentation of reasons that may support a request. Exceptions are not automatic and
will be granted on a case-by-case basis.
Reason for Request Minimum Supporting Documentation Required
Crisis Situation Letter on letterhead from legal, medical, or other relevant professional. Police report, court order,
airline ticket or relevant documents.
Death of immediate family member* Dated copy of death certificate, published obituary, or memorial folder. If student’s last name differs,
documentation required that establishes immediate family relationship to the deceased.
Financial Difficulties Documentation of a University error directly causing the financial problem. Please note: Financial
exception are rarely approved, unless there are special circumstances; student are responsible for
managing their personal finances.
Instructional Difficulties Supporting information and recommendation by department chair or dean.
Job Conflict Employer’s letter on letterhead confirming date and necessity of job changes. Please note: Voluntary
work schedule changes or commitments made by the student are rarely approved unless exceptional
circumstances can be documented. Students are responsible for management of personal scheduling
that may impact their educational commitments.
Medical Condition (student or Doctor’s letter on letterhead verifying dates of treatment, and nature of condition as pertains to normal
immediate family member* only) school activities.
Military Duty Copy of official order to report for training of active duty.
Registration Problems/Advising Error Relevant supporting documentation, ie: email or other correspondence with University personnel about
registration difficulties or written statement from academic advisor.
Other Reason Written documentation from relevant officials of entities on company letterhead or similar.
*Immediate Family is defined as: father, mother, brother, sister, husband, wife, domestic partner, son or daughter.
