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.
Faculty/Staff’s Full Name:
If the committee has questions during their review, how should the contact you?
Please state category of your petition:
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
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)
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.
Faculty Advisor’s Full Name:
Suspected Honor Code Violations and Professionalism Alerts should be reported using the Professionalism Alert form (Non-Academic Alert Form).
Suspected Scholastic Honesty Violations should be reported using the UT Tyler Scholastic Dishonesty Report Form.
Requests for a Grade Appeal should be completed using the UT Tyler Grade Appeal Form. Form revised 05/24/19