Petition Form - Northeastern University
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1
2Graduate School of Engineering
Phone: 617.373.2711
130 Snell Engineering Center
Fax: 617.373.2571
Northeastern University
Web:
360 Huntington Avenue
Boston, MA 02115-5000
PETITION FORM
Follow the instructions on the next page. Use fillable pdf or PRINT CLEARLY to ensure your writing is legible. You
must provide all required supporting documents before a final decision is made on your petition.
NU ID ________________________________ Current Program/Concentration _______________________________
Name _________________________________ _______________________________ ________________________
Last or Family Name
First or Given Name
Middle Name
Phone _________________________________ Husky E-mail ________________________________@husky.neu.edu
Current Degree Level:
M.S.
Ph.D.
Special Student
International
Domestic
1. Check all that apply:
Elective outside core curriculum (M.S. degree only)
Change in status
Core course waiver
Extension of 7-year time limit
Course substitution
Transfer credit
Other (specify): _____________________________________________________________________________
2. For each course concerned, please provide the information below:
Course Name
Term
CRN #
Course #
# Credits
3. What are you petitioning? Please explain (attach separate sheet if necessary): ________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
4. Student Signature: _____________________________________________________
Date: _________________
SUBMIT PETITON AND ANY SUPPORTING DOCUMENTS TO YOUR PROGRAM ADVISOR
Program Advisor
Recommendation:
Approved
Denied
___________________________________________________
___________________________________________
Signature
Print Name
_____________________________________________________________________________
_________________
Advisor’s comments and/or instructions
Date
_____________________________________________________________________________
_________________
ECE Graduate Committee Chair (ECE students only)
Date
Graduate School:
Approved
Denied
No Action
Returned for additional information
ASC Report filed
Comments to student: _______________________________________________________________________________
______________________________________ _______________________________ ________________________
Graduate school authorization
Date
Effective Term
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