Form 13-0570 - General Petition Form Undergraduate
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2General Petition Form UNDERGRADUATE
Please see the second page of this form for directions for filing a petition
Petitioner Information:
Name _____________________________________________________________________Major________________________________
ID# _______________________ Phone _______________________ Chapman email _________________________________________
I do hereby petition for:
Course Number and Section __________________ Term___________________Credits________________ Grade Option_____________
o Challenge of Grade on Course
o Late Add of Course*
o Late Withdrawal of Courses*
*Attach receipt for petition fee
o Overload of Credit (Non-Probation)
o Overload of Credit (Probation)
o Request for Waiver of Requirement Due to Misadvisement
o GE Approval Request
o Other
ATTACH A TYPED SHEET (ONE PAGE MAX) EXPLAINING WHY AN EXCEPTION TO POLICY IS WARRANTED.
This petition is for academic purposes only and in no way affects your financial obligation to the University.
Signature____________________________________________________ Date_______________________________
See back of form to determine which of the signatures below (if any) are required. If a petition is submitted without the required signatures,
it will be returned unanswered.
Faculty/Program Advisor ______________________________________________________ Date____________
o
Recommended
o
Not Recommended
o
Neutral
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Department Chair ___________________________________________________________ Date____________
o
Recommended
o
Not Recommended
o
Neutral
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Internship Coordinator ________________________________________________________ Date____________
o
Recommended
o
Not Recommended
o
Neutral
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Instructor ________________________________________________________________ Date____________
Recommended
Not Recommended
Neutral
o
o
o
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Academic Advising Center ______________________________________________________ Date____________
o
Recommended
o
Not Recommended
o
Neutral
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Office of the Chancellor ________________________________________________________ Date____________
o
Recommended
o
Not Recommended
o
Neutral
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Office of Disability Services _____________________________________________________ Date____________
Recommended
Not Recommended
Neutral
o
o
o
Print Name
Signature
Comments ___________________________________________________________________________________________________________________
Office Use Only:
Your Petition has been
_________________Approved
_________________Denied
Per the o Academic Council o GE Committee o Petitions Sub-Committee o Student Standards Committee
Comments: _____________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
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Parent category: Education