Petition Form - Cornell Engineering (Cornell University)
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1
2Received: ___/___/___ By: _____
CORNELL UNIVERSITY ∙ COLLEGE OF ENGINEERING
Entered db: ___/___/___ By: _____
P E T I T I O N
Entered decision: ___/___/___
By: _____
READ instructions on reverse side & please print neatly
Please Check One:
Undergraduate
M.Eng Graduate
Undergraduate
Major, if affiliated:
_____________________
_________________
Last name
First name
Middle initial
ID # (7 digit)
_
_______________________
_________________
_____________________
Email for reply
Current Phone #
Undergrad.Major, if affiliated
Are you an international student?
YES
NO
M.Eng. Field, if Graduate
Are you an NCAA varsity student-athlete? YES
NO
_____________________________________________
_____________________
Faculty Advisor (PRINT)
Department
Expected graduation date
***This form is NOT to be used if you are petitioning a liberal studies substitution;
please use the liberal studies substitution petition form instead.
I HEREBY REQUEST (state rationale for request):
__________________________________
Signature, date
FACULTY ADVISOR’S STATEMENT:
__________________________________
Signature, date
COLLEGE ACTION (for Registrar/Advising Office use only):
____ Request Approved
____ Request Denied
Comments:
__________________________
Signature, date
RETURN TO ENGINEERING REGISTRAR’S OFFICE, 158 OLIN HALL
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Parent category: Legal