PETITION FOR ACADEMIC RENEWAL

Name: Soc. Sec. No. 
 
Local Address:
Street City, State Zip Code

Daytime
Phone No.: Date of Petition: 

Do you request that one semester or all previous coursework be voided?
one semester
all previous coursework

Semester(s) for which academic renewal is requested:

Have you filed an undergraduate degree program? Yes No

I certify that I understand the conditions necessary to be eligible for academic renewal. I also realize the effects that academic renewal will have on my status relative to academic programs and degree requirements, as well as financial aid and athletic eligibility. In addition, I understand that the voided coursework will remain a part of my permanent academic record even though it will not count toward graduation or the computation of my grade point average. 
 

 
Student's Signature  Date 
TO BE COMPLETED BY OFFICE OF THE REGISTRAR
 
Approval 
Disapproval 

Reason 

Judy S. Byrd
Assistant Registrar		 Date