www.graduate.vcu.edu/pdfs/spec_action_form.doc
TO BE PLACED IN THE STUDENTS ACADEMIC FOLDER)
Extension of time limit for degree: From beginning of sem/yr
_______________ through end of sem/yr ______________
Leave of absence: From beginning of sem/yr ____________________
through end of sem/yr _____________________
Course overload: Number of credits ___________________________
Semester/year ___________________________
Authorization of courses to count towards degree (transfer; excess
of 6 hours as non-degree seeking student):
Course number/title牋
Course number/title牋
Course number/title牋
Termination by program for cause (Student to be notified by Graduate
Dean)牋 Effective sem/yr
Withdrawal from program: (Attach completed UES Course牋
Effective sem/yr
Request Form if
also withdrawing from courses)
Condition for readmission, if applicable牋
Other:牋
Department Chair/Designee燚ate
Deans Designee燚ate
APPROVAL BY
DEAN, SCHOOL OF GRADUATE STUDIES (SUPPORTING DOCUMENTS ATTACHED)
Change provisional admission granted for academic reasons to full
admit: Effective sem/year ______________________
Second job approval for student on stipend:燘egin ____________________
End _____________________
Withdrawal from courses after withdrawal deadline燛ffective date
牋牋牋
(Attach completed UES Course Request Form & FA Impact of Retroactive
&/or Mid-semester Changes to Enrollment Form)
牋牋牋牋
___ Drop
from courses after drop deadline燛ffective date _______________________________________
(Attach completed
UES Course Request Form & FA Impact of Retroactive &/or Mid-semester
Changes to Enrollment Form)
Termination from University for cause:燛ffective date牋
Department Chair/Designee燚ate
Deans Designee燚ate
Dean, School of Graduate Studies燚ate