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First name:

Last name:

MyLaurier email (@mylaurier.ca)

Laurier ID:

Home faculty:

Program:

What is the nature of your petition?
Please select all that apply.

Requesting term(s) 'Not Accountable'

Submission of late course work (course outline(s) must be submitted with petition)

Probation extension

Late drop (I want to withdraw from a course after the official deadline)

Third attempt at a course

Multiple late drop (I want to withdraw from more than one course after the official deadline)

Retroactive letter of permission

This is related to the SAS (Strategies for Academic Success) Program

Late add (I want to register for a course after the official deadline). NOTE: You must include evidence of support from the instructor to add the course. Instructor support does NOT guarantee approval.

Other

Multiple late add request (I want to register for more than one course after the official deadline). NOTE: You must include evidence of support from the instructor to add the courses. Instructor support does NOT guarantee approval.

You selected "Other". Please specify:

Please include course code including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code #1 including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code #2 including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code #3 including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code #4 including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code #5 including the section:

Indicate if Fall, Winter or Spring term:

Name of Instructor:

Please include course code including the section:

Indicate if Fall, Winter or Spring term:

"Not Accountable" term:

Please indicate what term (and year) you are requesting "Not Accountable". (E.g. Fall 2018, Winter 2019, or Spring 2020 term. If more than one term, please indicate all terms you refer to).

Have you submitted the following three items for documentation?

1. Letter of permission request form?

Yes
No

2. An official transcript?

Yes
No

3. Department approval?

Yes
No

Please include course code including the section:

Name of instructor(s):

Please outline the outstanding work you have left to complete.

Personal statement:
Please provide an explanation on your reasons why this petition should be considered. Be as detailed as necessary.

Supporting documentation:
If you're providing supporting documentation, please indicate what type of documentation (select all that apply).

Health and Wellness (e.g. Physician, Counsellor, Verification of Illness form)

Course outline(s)

Compassionate circumstances (e.g. Obituary, Funeral program, Wedding invitation)

Other (e.g. Employer, Clergy, Legal)

Laurier personnel (e.g. Dean of Students, ALC Consultant, Course Instructor)

Please specify what 'Other' type of documentation is being submitted.

File upload (supporting documentation):
If you have any supporting documents to upload, please drag and drop your file here or click to upload.

File upload (supporting documentation):
If you have any supporting documents to upload, please drag and drop your file here or click to upload.

File upload (supporting documentation):
If you have any supporting documents to upload, please drag and drop your file here or click to upload.

Acknowledgement:

I hereby confirm that the above information is true and accurate.

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