COURSE PETITION OR SECTION CHANGE REQUEST
ENVIRONMENTAL STUDIES PROGRAM
[Fill in all blanks, answer all questions, and circle wherever a choice is given]
Were you unable to register for the course that you are requesting?
Are you registered and requiring a change in section?
1. Name ______________________________________________
(Last)
(First)
(Middle initial)
3. Binghamton Email ____________________________________
5. Harpur / Other (specify) _____________________
7. Sr / Jr / Soph / Fresh
Yes / No
Yes / No
2. Phone ________________
(Local or cell phone)
4. B-number______________
6. Major? ______________________________
8. No. of credits in progress ______ 9. No. of credits already completed ___
10. Course: (number and name)
_______________________________________________
11. If requesting section change, indicate section already registered in: _____
12. Enter sections in order of preference. Fill blanks with CRN#
Lecture _____
Activity (1) ________ Discussion (1) _______
(2) ________
(2) _______
(3)_________
(3) _______
If I cannot have my preference,
place me in any section that fits my
schedule.
Yes / No Initial only if yes______
13. Explain why you need the course or change in section.
14. Will registering for this course cause an overload? Yes / No
If yes, is your GPA high enough to overload? Yes/No
15. Will registering for this course cause a time conflict? Yes / No (consider lecture, activity, disc)
16. Do you want the Dept. to drop a course for you if your petition is granted? Yes / No
Give number and title of course that you want dropped. ___________________________________
(If nothing is to be dropped, write NONE)
17. It is your responsibility to contact the instructor if you DO NOT wish this action to be taken. If your
petition is not withdrawn and a seat opens for you in the course, we will add you if possible. If we
cannot add you due to time conflict, credit limit, or any hold, we will move on to the next person on
the waiting list.
18. Your signature indicates that you are filing this petition AND indicating what course to drop.
Student's Signature______________________________________ Date ________________
19. Checklist for submission:
___ Did you answer all questions?
___ Did you sign and enter the date in #18?
___
Checked to make sure you have no time conflicts or outstanding fines or delinquencies?
Faculty member's decision
Approved / Denied (pls circle)
If approved, which section(s)?
________________
Signature______________________________________
Date ________________
Office action
Able to register student. Entered by ________________
Unable to register student because:
Date _______________
Student notified by ______________________________
Date __________________
July 2012