ASSUMPTION UNIVERSITY

GRADUATE SCHOOL Serial No. _____________________

PETITION Study Program _________________

INSTRUCTION: Fill up your request clearly and completely.

This petition may be used to request several actions by the University. A separate petition is required for each request and covers
only the specific request you are making.

Mr. Ms. Mrs. Admission I.D.: [ ][ ][ ]--[ ][ ][ ][ ]

NAME:
Name Surname

ADDRESS: ___________________________________________________________________________________________________
____________________________________________________ Tel. _______________________________________

State specific request, outlining completely pertinent facts and details to support your request.
Attach additional sheet if necessary.

REQUEST FOR:

Add Course(s) Change Section Make - Up Exam

Withdraw Course(s) Change Subject Audit for Comprehensive

# Subject & Section: ___________________________________________________________________________

# Instructor Name: _______________________________Semester: ___________________________________

Maintain Student status Change Program Transfer Credit(s) Other

#___________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

______________________________________________________________________
Reasons (s):
_______________________________________________________________________________
SIGNATURE _______________ DATE ___/___/___

Graduate Schools' comments/approval Advisor or Dept. Chairperson's comments/approval

______________________________________________ __________________________________________________
______________________________________________ __________________________________________________
______________________________________________ __________________________________________________
______________________________________________ __________________________________________________
______________________________________________ __________________________________________________
Signature _____________ Date ___/___/___ Signature ______________ Date ___/___/___

Student's Acknowledgement ACADEMIC ACTION

Fine/Fee receipt. No. Approved Rejected

Amount due Comments

Signature ______________ Date ___/___/___ Signature _______________ Date ___/___/___

Vice President for Academic Affairs
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Please Fill Out This Part For Office Use Only

Admission I.D. [ ][ ][
Program of Study: ___________________________
Mr. Ms. Mrs. __________________________________
Request for ___________________________________
_______________________________________________________
Submission Date ____/____/____
] -- [ ][ ][ ][ ] Serial No. ____________
Please contact the Office of Graduate School
#_________________________________________________________
_________________________________________________________
_________________________________________________________
Staff Signature _____________ Date ___ / ___ / ___