OUSA
OFFICE
USE
ONLY
Processed by ___________
Date _________
First Name: ___________________ Last Name: __________________ Student ID: _________
Net ID: _______ NU Email: _____________________@u.northwestern.edu
Home School: __________________
Year of Entry to Northwestern: 20___
Planned Graduation Term: __________
In a Dual Degree Program: ___
Current Class: _________ Y
Planned Graduation Year: 20___
I have petitioned to graduate: Yes ___ No ___
Check all that apply: Declaring a Minor ___ Dropping a Minor ___ Changing Concentration ___
Minor to Declare: ______________________________
Concentration (if applicable): _______________________ Catalog Requirement Year*: ________
Previously Declared Major(s) /Minor(s) to RETAIN:
Major(s): _________________________ __________________________
Minor(s): _________________________ __________________________
Previously Declared Major(s)/Minor(s) to DROP:
Instructions for Students:
1. Use Adobe Acrobat or Reader to fill out this form.
2. Save as a .pdf named: “<Your Last Name>_<Your Student ID>”.
3. Email to the department/program adviser or director of undergraduate studies.
Instructions for Department/Program:
1. Review the student’s information and follow up with them if necessary.
2. Digitally sign the form and save it.
3. Email completed and approved form to: wcas-forms@northwestern.edu
Department/Program Name: ____________________
Department or Program Approver Digital Signature: _______________________
Major(s): _________________________ __________________________
Minor(s): _________________________ __________________________
*This is the year of the Undergraduate catalog whose
requirements you are following. Please consult your
department/program adviser with questions.
click to sign
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