Petition Type and #:
Issue Date:
Submission Date:
Term and Year:
Class Time Conflict Petition to the Academic Standards Committee
Student:
UPSID:
Mailing Address:
Telephone Number(s):
I request permission to register for:
Dept/Number/Section
Days/Times
Instructor
Dept/Number/Section
Days/Times
Instructor
Despite the schedule conflict with:
I have made the following arrangements to accommodate the conflict in my schedule and to compensate for the
class time I will miss:
I understand my petition will be decided not only in consideration of the arrangements I have made, the burden
on the instructors, and the disruption to either class, but also in consideration of the compelling nature of my
desired schedule. Therefore, I have attached a statement explaining why I am requesting registration in these
classes and why I have not chosen a schedule free of conflict.
Student’s Signature
I support this arrangement.
Instructor’s Signature
I support this arrangement.
Date
I support this arrangement.
Advisor’s Signature
Date
Instructor’s Signature
Date
Academic Standards Committee Decision:
Date
Processed:
Registrar’s Signature
Date