UNDERGRADUATE STUDENT PETITION
REASON FOR PETITION & APPROVAL SIGNATURES NEEDED (see approver codes in parentheses)
Requesting a Substitution or Exception for: Other Reasons for Petition:
Adding a credit to a class (A, I) must attach list Core Requirement (A, CD) ___ ___
Major Requirement (A, CH) ___
Mi
nor Requirement (PD or CH) ___
Subs
titute PED Requirement (AD) ___
Wai
ve PED Requirement (AD, CD) ___
Ot
her ___
of extra work required to earn the credit
___REQUEST an Incomplete grade (I)
___EXTEND an Incomplete grade (I, D)
___Overload beyond 19 credits (A, CH)
___Repeat a course more than once (A, CH)
___Seniors – enroll in graduate course(s) (A, GPD, D)
___Time conflict (overlap) (I – both
courses)
KEY TO APPROVER CODES
A = Advisor CH = Department Chair
AD = Athletics Director D = Dean
CD = Core Director I = Instructor
GPD = Graduate Program Direc
tor
PD = Program Director
D
escribe in detail your request for this petition (if applicable, be sure to include course subject & number)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
__ _____________________ ___________________________________________________________________________________
Approver Signature and Title Date
_____________________________________________________________________________________ ____________ _________
Approver Signature and Title (if needed) Date
_____________________________________________________________________________________ ____________ _________
Approver Signature and Title (if needed) Date
QUICK GUIDE OF APPROVERS (ADDITIONAL HELP WITH THIS IN REGISTRAR’S OFFICE, SMYTH 1)
AD = Pete Bothner, pbothne4@naz.edu, Shults 129A, 585-389-2196
CD = Dr. Kelly Hutchinson-Anderson, khutchi8@naz.edu, Peckham 325, 585-389-2154
D = Dean (reach out to the Dean of the College/School in which the course in question resides)
C
ollege of Arts & Sciences: Dr. Dianne Oliver, doliver9@naz.edu, Golisano 403, 585-389-2391
School of Education: Dr. Kate DaBoll-Lavoie, kdaboll9@naz.edu, Golisano 275, 585-389-2618
School of Health & Human Services: Dr. Brigid Noonan, bnoonan8@naz.edu, Smyth 121. 585-389-4639
School of Management: Dr. Kenneth S. Rhee, krhee9@naz.edu, Smyth 147, 585-389-2606
Office of the Registrar • Smyth 1 • 4245 East Ave • Rochester, NY 14618
Phone (585) 389-2816 • Fax (585) 389-2612
__________________________ _______________________________________
Last Name First Name
Class (FR, SO, JR, SR)__________________________________ ___________
Phone Number
Current GPA___________________________________ ______________________
Email
Student Signature Date
_________________________________________________ _______________
Student ID__________________________
Major______________________________
Advisor_____________________________
Official use only Comment_________________________________________________________________________
________________________________________________________________________________________________
DateSignatureCopy to student_______ __________________________________________ ______________
