School of Social Sciences
Undergraduate Student Petition
NOTE: Please provide supporting documentation for your petition request, such as a course
description and syllabus. It is the student’s responsibility to retain their copy of the petition and pick it
up from the Social Sciences Undergraduate Student Affairs Office. If you have any questions
regarding this petition, contact our office via email at socsci@uci.edu.
NAME: ______________________________________________________________________________________________________________
STUDENT ID #:
_________________________________________________
MAJOR(S) ________________________________________________________
PHONE: _______________________________________________
DATE: ______________
CLASS LEVEL: FROSH
SOPH
JUNIOR
SENIOR
EMAIL: _____________________________________
-- Please Print Legibly or Type --
This is my request: (please be explicit in explaining what you are requesting):
Reason(s) for request: (please list all relevant reasons why you are making your request, be detailed):
Signature: ____________________________________________________________________
Date: ________________
-- Office Use Only -Petition is:
GRANTED _______
DENIED _______
COMMENTS: __________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Faculty Approval (if required): _____________________________________________________
Date: _______________
DEAN’S SIGNATURE: _______________________________________________________________
Date: _______________
student petition.doc
03/07/16