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The University of Texas at Tyler (University of Texas at Tyler)

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The University of Texas at Tyler
Ben and Maytee Fisch College of Pharmacy
Office of Academic Affairs
Professional and Academic Standards Committee (PASC) Petition
General Information: This form is typically completed by the student requesting the review. See page 2 for an overview of the PASC Petition/Appeal process.
General Instructions: Please save this form to your computer and then complete the form. When finished, attached the completed form to an email. Filling
out the form solely on the website will result in submission of a blank form.
Student’s Full Name:
Student ID #:
Preferred Phone Number:
Academic Year:
☐P1 ☐P2 ☐P3 ☐P4
Patriot Email:
@patriots.uttyler.edu
☐Other:
Course Number and Title:
Faculty/Staff’s Full Name:
Faculty/Staff Email:
If the committee has questions during their review, how should the contact you?
Please state category of your petition:
1,2,3
☐
Registration (e.g., Retroactive Withdrawal, Grade Forgiveness)
☐
Academic Probation (e.g. permission to continue coursework, modify prerequisites)
☐
Academic Dismissal (e.g. request to return to the program and/or resume coursework)
☐
Experiential Site Placements
☐
Other:
Please attach the following items to your PASC Petition
Please note: The PASC petition and all accompanying documents are formal documentation that is placed in to your permanent record.
Please complete the petition in a professional manner and with the appropriate writing skills necessary to reflect the seriousness of the situation.
1. Personal statement regarding the basis for your petition along with documentation as needed. This
statement should clearly indicate what you are requesting the PASC to consider.
2. Copy/ies of your current UT Tyler Transcript(s); an unofficial copy may be used.
3. Copy/ies of the Canvas electronic grade book for any course(s) involved in a registration, academic
probation, or academic dismissal concern.
4. Copy/ies of all experiential site assignment(s) for any experiential site placement concerns.
It is strongly suggested that you meet with your faculty advisor and discuss your situation before submitting your petition. Your faculty advisor will be
permitted to attend and
participate in the meeting. Your faculty advisor also will be able to serve as counsel during the meeting if necessary.
For petitions that relate to coursework (i.e. Registration, Academic Probation, Dismissal, Exponential Placements), the PASC will request information from
the course coordinator. For petitions that relate to Scholastic Honesty or Professionalism Alerts, the PASC may request information from the faculty/staff
members related to the event. The Student’s Personal Statement is provided to the PASC, the Office of Academic Affairs, and the Dean (for appeals)
Date:
Your advisor’s signature indicates that they have read the petition and discussed your petition with you. It does not mean that they endorse or agree with
the content of the petition.
Date:
Email:
1
Suspected Honor Code Violations and Professionalism Alerts should be reported using the Professionalism Alert form (Non-Academic Alert Form).
2
Suspected Scholastic Honesty Violations should be reported using the UT Tyler Scholastic Dishonesty Report Form.
3
Requests for a Grade Appeal should be completed using the UT Tyler Grade Appeal Form. Form revised 05/24/19
Page 2: Student’s Personal Statement (You may add additional pages if needed)
Overview of the PASC Petition and Appeal Process
1. Students may submit a PASC appeal within 14 calendar days of receiving an academic notification.
2. The PASC will request information from course coordinators (for course related concerns) and may request
information from faculty/staff for professionalism concerns.
3. The PASC will review the petition and, if necessary, contact the involved student/faculty/staff for additional
information.
4. The PASC will notify the student of their decision within 30 calendar days. Notification will be through the student's
official UT Tyler email. It is the student's responsibility to check their emails in a timely manner.
5. The student may appeal the PASC's decision within 14 calendar days of the date the notification email was sent. The
appeal must be submitted in writing and submitted to the Office of Academic Affairs, who will submit the appeal
request and any additional information to the Dean. In the appeal, please include the reason why you believe the
appeal should be granted. Be sure to attach any additional documentation or information to this form.
6. The Dean will review the appeal and notify the student of their decision within 30 calendar days of receiving the
appeal. The decision of the Dean is final. There is no further appeal process.
PLEASE SUBMIT THIS FORM TO THE OFFICE FOR ACADEMIC AFFAIRS
ATTN: Dr. Kathleen Snella • ksnella@uttyler.edu • Fax 903.565.5598
Professional and Academic Standards Committee (PASC) Petition
Page 3: Faculty Member’s Comments (for Course-Related Petitions)
Student’s Full Name:
Student ID #:
Patriot Email:
@patriots.uttyler.edu
Academic Year:
☐P1 ☐P2 ☐P3 ☐P4
Course Number and Title:
Faculty/Staff’s Full Name:
Faculty/Staff Email:
PASC Petition Concerns:
☐
Registration (e.g., Retroactive Withdrawal, Grade Forgiveness)
☐
Academic Probation (e.g. permission to continue coursework, modify prerequisites)
☐
Academic Dismissal (e.g. request to return to the program and/or resume coursework)
☐
Experiential Site Placements
☐
Other:
The student listed above has submitted a petition to the PASC. As the course coordinator, the committee is requesting
information surrounding this request. Please provide any information you feel is important and that relates to the request
indicated above. When appropriate, please be specific and include any relevant dates and/or communications sent to the
student as it relates to the petition. If there is specific information the committee is requesting, it is listed below.
Please provide the information requested in the space provide. You may attach additional sheets as needed. If you have no additional
comments, please indicate this in the space provided. A copy of this statement is not provided to the student.
Faculty/Staff Signature:
Date:
Faculty Advisor’s Full Name:
Email:
PLEASE SUBMIT THIS FORM TO THE OFFICE FOR ACADEMIC AFFAIRS
ATTN: Dr. Kathleen Snella • ksnella@uttyler.edu • Fax 903.565.5598
Professional and Academic Standards Committee (PASC) Petition
Page 4: Professional and Academic Standards (PASC) Response
The student’s PASC petition was ☐ granted; ☐denied; or ☐ other
Comments and/or specific terms of the PASC decision:
An official letter with the PASC decision will be sent to the student via their UT Tyler email.
☐ Student cc: ☐ Office of Academic Affairs (student file)
☐ Academic Advisor
☐ Other: __________________________________________________________
☐ Other: __________________________________________________________
PASC Chair Signature:
Date:
PASC Chair Name:
Email Address:
Appeal of the Professional and Academic Standards (PASC) Decision to the Dean
☐ Appeal was received on: _________________________
☐ A copy of the PASC decision letter was forwarded to the Dean
☐ Additional information sent to the Dean included:
Dean, Fisch College of Pharmacy Response:
The student’s appeal of PASC petition was ☐ granted; ☐denied; or ☐ other
An official letter with the Dean’s decision will be sent to the student via their UT Tyler email.
☐ Student cc: ☐ Office of Academic Affairs (student file)
☐ Chair, Professional and Academic Standards Committee.
☐ Academic Advisor
☐ Other: __________________________________________________________
☐ Other: __________________________________________________________
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Completed 24 July 2020

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